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Journal of Gastrointestinal Surgery

, Volume 18, Issue 4, pp 869–877 | Cite as

Pancreaticoduodenectomy After Bariatric Surgery: Challenges and Available Techniques for Reconstruction

  • Ioannis Hatzaras
  • Teviah E. Sachs
  • Matthew Weiss
  • Christopher L. Wolfgang
  • Timothy M. PawlikEmail author
Review Article

Abstract

Introduction

Obesity is an epidemic in the USA, with approximately 7 % of the population considered morbidly obese (BMI > 40 or >35 with significant comorbidities).

Discussion

Weight loss surgery is recognized as a durable solution to both obesity and obesity-associated morbidities. With an increasing number of pancreatic lesions being discovered on cross-sectional imaging, the pancreatic surgeon is increasingly likely to encounter patients with prior bariatric surgery who are in need of pancreaticoduodenectomy. As such, surgeons need to be familiar with the various bariatric operations, as well as the manner in which to handle prior bariatric reconstructions at the time of pancreatic surgery. Literature on this topic, however, is scarce with only a handful of small case series.

Conclusion

We herein review the different operations performed for weight loss, as well as provide an overview of the available operative approaches for reconstruction after pancreaticoduodenectomy in postbariatric surgical patients.

Keywords

Obesity Bariatric Whipple Reconstruction 

Notes

Disclosures

None

References

  1. 1.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA : The Journal of the American Medical Association. Jan 20 2010;303(3):235–241.Google Scholar
  2. 2.
    Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). Sep-Oct 2009;28(5):w822-831.Google Scholar
  3. 3.
    Eheman C, Henley SJ, Ballard-Barbash R, et al. Annual report to the nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer. May 1 2012;118(9):2338–2366.Google Scholar
  4. 4.
    Wiseman M. The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. The Proceedings of the Nutrition Society. Aug 2008;67(3):253–256.Google Scholar
  5. 5.
    Schirmer B. SPR. The surgical management of obesity. Schwartz’s Principles of Surgery, 9e. F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Chapter 27. 2010.Google Scholar
  6. 6.
    Nikfarjam M, Staveley-O’Carroll KF, Kimchi ET, Hardacre JM. Pancreaticoduodenectomy in patients with a history of Roux-en Y gastric bypass surgery. JOP: Journal of the Pancreas. 2009;10(2):169–173.PubMedGoogle Scholar
  7. 7.
    Rutkoski JD, Gagne DJ, Volpe C, Papasavas PK, Hayetian F, Caushaj PF. Pancreaticoduodenectomy for pancreatic cancer after laparoscopic Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery. Jul-Aug 2008;4(4):552–554; discussion 554–555.Google Scholar
  8. 8.
    Theodoropoulos I, Franco C, Gervasoni JE, Jr. Pancreaticoduodenectomy for pancreatic carcinoma after complicated open Roux-en-Y gastric bypass surgery: an alternative approach to reconstruction. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery. Sep-Oct 2012;8(5):648–650.Google Scholar
  9. 9.
    Barbour JR, Thomas BN, Morgan KA, Byrne TK, Adams DB. The practice of pancreatic resection after Roux-en-Y gastric bypass. The American Surgeon. Aug 2008;74(8):729–734.Google Scholar
  10. 10.
    Amit S Khithanil, David E Curtis, Christos Galanopoulos, Dhiresh Rohan Jeyarajah. Pancreaticoduodenectomy after a Roux-En-Y gastric bypass. Obesity Surgery. 2008;19(6):4Google Scholar
  11. 11.
    Ni Mhuircheartaigh JAS, Bennett AE, Tyagi G. Imaging features of bariatric surgery and its complications. Semin Ultrasound CT MR. 2013;34(4):13CrossRefGoogle Scholar
  12. 12.
    Khashab MAOP. Accessing the pancreatobiliary limb and ERCP in the bariatric patient. Gastrointest Endosc Clin N Am. 2011;21(2):8Google Scholar
  13. 13.
    Schreiner MACL, Gluck M, Irani S, Gan SI, Brandabur JJ, Thirlby R, Moonka R, Kozarek RA, Ross AS. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc. 2012;75(4):8Google Scholar
  14. 14.
    Todd H, Baron LMWKS, Lincoln Ferreira EVV, Thomas C. Smyrk. Novel approach to therapeutic ERCP after long-limb Roux-en-Y gastric bypass surgery using transgastric self-expandable metal stents: experimental outcomes and first human case study (with videos). Gastrointestinal Endoscopy. 2012;75(6):5Google Scholar
  15. 15.
    Iacono CRA, Campagnaro T, Bortolasi L, Valdegamberi A, Guglielmi A. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection: highlights and drawbacks. Annals of Surgery. 2013;257(2):14CrossRefGoogle Scholar
  16. 16.
    Gudzune KAHM, Chang HY, Asamoah V, Gadgil M, Clark JM. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obesity Surgery. 2013;23(10):9CrossRefGoogle Scholar
  17. 17.
    Majumder S., Soriano J., Louie Cruz A., Dasanu CA. Vitamin B12 deficiency in patients undergoing bariatric surgery: preventive strategies and key recommendations. Surg Obes Relat Dis. May 2013 2013. doi: 10.1016/j.soard.2013.04.017
  18. 18.
    Choban PSFL. The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes Surg. 2002;12(4):6CrossRefGoogle Scholar
  19. 19.
    Orci LCM, Huber O. Short versus long Roux-limb length in Roux-en-Y gastric bypass surgery for the treatment of morbid and super obesity: a systematic review of the literature. 2011;21(6):8.Google Scholar
  20. 20.
    Nguyen NTMH, Magno CP, Nguyen XM, Laugenour K, Lane J. Trends in the use of bariatric surgery, 2003–2008. Journal of the American College of Surgery. 2011;213(2):6CrossRefGoogle Scholar
  21. 21.
    Higa K, Ho T, Tercero F, Yunus T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery. Jul-Aug 2011;7(4):516–525.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Ioannis Hatzaras
    • 1
  • Teviah E. Sachs
    • 1
  • Matthew Weiss
    • 1
  • Christopher L. Wolfgang
    • 1
  • Timothy M. Pawlik
    • 2
    Email author
  1. 1.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA
  2. 2.Department of SurgeryBaltimoreUSA

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