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Pancreatic Head Resection Following Roux-en-Y Gastric Bypass: Operative Considerations and Outcomes

  • 2019 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

This study aimed to identify optimal management decisions for surgeons preforming pancreatic head resection on patients with altered anatomy due to a previous Roux-en-Y gastric bypass (RYGB).

Methods

A multi-national (4), multi-center (28) collaborative of 55 pancreatic surgeons who have performed pancreatoduodenectomy or total pancreatectomy following RYGB for obesity (2005–2018) was created. Demographics, operative details, and perioperative outcomes from this cohort were analyzed and compared in a propensity-score matched analysis with a multi-center cohort of 5533 pancreatoduodenectomies without prior RYGB.

Results

Ninety-six patients with a previous RYGB undergoing pancreatic head resection were assembled. Pathologic indications between the RYGB and normal anatomy cohorts did not differ. Propensity score matching of RYGB vs. patients with unaltered anatomy demonstrated no differences in major postoperative outcomes. In total 20 distinct reconstructions were employed (of 37 potential options); the three most frequent reconstructions accounted for 52.1%, and none demonstrated superior outcomes. There were no differences in outcomes observed between original biliopancreatic limb use (66.7%) and those where a secondary Roux limb was created for biliopancreatic reconstruction. Remnant stomachs were removed in 54.7% of cases, with no outcome differences between resected and retained stomachs. Venting gastrostomy tubes were used in 36.2% of retained stomachs without obvious outcome benefits. Jejunostomy tubes were used infrequently (11.7%).

Conclusions

Pancreatic head resection after RYGB is an infrequently encountered, unique and challenging scenario for any given surgeon. These patients do not appear to suffer higher morbidity than those with unaltered anatomy. Various technical reconstructive options do not appear to confer distinct benefits.

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Acknowledgments

We would like to acknowledge all surgeons that provided patients for this series: Reid B. Adams, Daniel E. Abbott, Taylor Aiken, Erin H Baker, Todd Bauer, Stefan Breitenstein, Kenneth Cardona, Sricharan Chalikonda, John A. Chabot, Eugene P. Ceppa, William C. Chapman, Carmen Solorzano, Jeffrey A. Drebin, Ronald DeMatteo, M. B. Majella Doyle, Kevin El-Hayek, Michael House, Hobart Harris, Steven J. Hughes, William G. Hawkins, David Iannitti, Major Kenneth Lee, David C. Linehan, John B Martinie, Atilla Nakeeb, Eric K. Nakakura, Lee M. Ocuin, Victoria Rendell, Charles Staley III, Conrad Simpfendorfer, Bruce D. Schirmer, Steven M. Strasberg, Jose G. Trevino, David Vogt, Matthew R Walsh, Jane S. Wey, Nicholas Zyromski.

Pancreatic Head Resection after Roux-en-Y Gastric Bypass Study Group

John D. Allendorf. Department of Surgery, New York University School of Medicine, New York, NY

Chad G. Ball. Department of Surgery, University of Calgary, Alberta, Canada

Jordan Baechle. Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN

Stephen W. Behrman. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN

Carlos Chan. Department of Surgery, Centro Medico ABC Observatorio, Mexico City, Mexico

Carlos U. Corvera. Department of Surgery, University of California, San Francisco Medical Center, San Francisco, CA

Jessica L. Cioffi. Department of Surgery, University of Florida College of Medicine, Gainesville, FL

Jash Datta. Department of Surgery, Memorial Sloane Kettering Cancer Center, New York, NY

Mary E. Dillhoff. Department of Surgery, Ohio State University School of Medicine, Columbus, OH

Katelyn F. Flick. Department of Surgery, Indiana University School of Medicine, Indianopolis, IN

Andrew. A. Gumbs. Centre Hospitalier Intercommunal Poissy/Saint-Germaine-en-Laye, Poissy, France

Lukasz Filip Grochola. Department of Surgery, Klinik für Viszeral- und Thoraxchirurgie, Winterthur, Switzerland

Kamran Idrees. Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN

Mohammad Raheel Jajja. Department of Surgery, Emory University School of Medicine, Atlanta, GA

David A. Kooby. Department of Surgery, Emory University School of Medicine, Atlanta, GA

Edward J. Kruse. Department of Surgery, Augusta University, Augusta, GA

Andrew M. Lowy. Department of Surgery, University of California, San Diego School of Medicine, San Diego, CA

Barbara A. Moskowitz. Department of Surgery, New York University School of Medicine, New York, NY

Daniel L. Maxwell. Department of Surgery, Emory University School of Medicine, Atlanta, GA

Gareth J. Morris-Stiff. Department of Surgery, Cleveland Clinic, Cleveland, OH

Katherine A. Morgan. Department of Surgery, The Medical University of South Carolina, Columbia, SC

Victoria V. O’Connor. Department of Surgery, Kaiser Permante, Pasadena, CA

June Peng, Department of Surgery, Cleveland Clinic, Cleveland, OH

Beth A. Schrope. Department of Surgery, Columbia University Medical Center, New York, NY

C. Max Schmidt. Department of Surgery, Indiana University School of Medicine, Indianopolis, IN

Charles R. Scoggins. Department of Surgery, University of Louisville School of Medicine, Louisville, KY

Dominic E. Sanford. Department of Surgery, Washington University School of Medicine, St. Louis, MO

Jesse K. Sulzer. Department of Surgery, Carolinas Medical Center, Charlotte, NC

Juan M. Sarmiento. Department of Surgery, Emory University School of Medicine, Atlanta, GA

Mazhar Soufi. Department of Surgery, Indiana University School of Medicine, Indianopolis, IN

Paula M. Smith. Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN

Perry Shen. Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC

Rachel E. Simpson. Department of Surgery, Indiana University School of Medicine, Indianopolis, IN

Lee W. Thompson. Department of Surgery, Mobile Infirmary Health System, Mobile, AL

Valeria Vilchez, Department of Surgery, Cleveland Clinic, Cleveland, OH

Dionisios V. Vrochides. Department of Surgery, Carolinas Medical Center, Charlotte, NC

Andrew D. Wisneski. Department of Surgery, University of California, San Francisco Medical Center, San Francisco, CA

Curtis J. Wray. Department of Surgery, University of Texas McGovern Medical School, Houston, TX

Emily R. Winslow. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI

Gregory A. Williams. Department of Surgery, Washington University School of Medicine, St. Louis, MO

Victor M. Zaydfudim. Department of Surgery, University of Virginia School of Medicine, Charoletteville, VA

Author information

Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    M. T. Trudeau, L. Maggino, B. L. Ecker & C. M. Vollmer

  2. Department of Surgery, University of Verona, Verona, Italy

    L. Maggino

Authors
  1. M. T. Trudeau
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  2. L. Maggino
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  3. B. L. Ecker
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  4. C. M. Vollmer
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Consortia

the Pancreatic Head Resection after Roux-en-Y Gastric Bypass Study Group

  • John D. Allendorf
  • , Chad G. Ball
  • , Jordan Baechle
  • , Stephen W. Behrman
  • , Carlos Chan
  • , Carlos U. Corvera
  • , Jessica L. Cioffi
  • , Jash Datta
  • , Mary E. Dillhoff
  • , Katelyn F. Flick
  • , Andrew A. Gumbs
  • , Lukasz Filip Grochola
  • , Kamran Idrees
  • , Mohammad Raheel Jajja
  • , David A. Kooby
  • , Edward J. Kruse
  • , Andrew M. Lowy
  • , Barbara A. Moskowitz
  • , Daniel L. Maxwell
  • , Gareth J. Morris-Stiff
  • , Katherine A. Morgan
  • , Victoria V. O’Connor
  • , June Peng
  • , Beth A. Schrope
  • , Dominic E. Sanford
  • , Jesse K. Sulzer
  • , Juan M. Sarmiento
  • , Mazhar Soufi
  • , Paula M. Smith
  • , Perry Shen
  • , Rachel E. Simpson
  • , Lee W. Thompson
  • , Valeria Vilchez
  • , Dionisios V. Vrochides
  • , Andrew D. Wisneski
  • , Curtis J. Wray
  • , Emily R. Winslow
  • , Gregory A. Williams
  •  & Victor M. Zaydfudim

Contributions

Conception/design (MT Trudeau, L Maggino, BL Ecker, CM Vollmer); data acquisition (MT Trudeau, CM Vollmer, and all members of the Pancreatoduodenectomy after Roux-en-Y Gastric Bypass Study Group); data interpretation (MT Trudeau, L Maggino, BL Ecker, CM Vollmer); critical revisions (all authors); final approval (all authors).

Corresponding author

Correspondence to C. M. Vollmer.

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Presented as an Oral Presentation at the Society for Surgery of the Alimentary Tract (SSAT) 2019 Annual Meeting, San Diego CA May 19, 2019

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Trudeau, M.T., Maggino, L., Ecker, B.L. et al. Pancreatic Head Resection Following Roux-en-Y Gastric Bypass: Operative Considerations and Outcomes. J Gastrointest Surg 24, 76–87 (2020). https://doi.org/10.1007/s11605-019-04366-y

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  • DOI: https://doi.org/10.1007/s11605-019-04366-y

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