Reconstructive strategy after pancreaticoduodenectomy in partially gastrectomized patients.

Context: Pancreaticoduodenectomy in partially-gastrectomized patients presents some peculiarities of the reconstructive phase. Above all, in B II and Roux-en-Y partial gastrectomies, a gastric re-resection with a redo gastrojejunal anastomosis should be avoided because it is often needlessly time-consuming and risky. In our series of 7 consecutive patients, either one of two reconstruction methods was used, depending upon the length of the pre-existing afferent loop.

Case reports: In order to better illustrate this strategy, two cases of carcinoma of the duodenal papilla are reported. Both of the patients had previously undergone partial gastrectomy with B II reconstruction for peptic ulcers. Both were admitted to our hospital with a past history of jaundice. However, whereas in Case #2 a sufficiently long pre-existent afferent loop could be utilized for the pancreatic and bile duct anastomoses, in Case #1 a shorter afferent loop was removed and the efferent loop was utilized for the anastomoses. The postoperative course was uneventful in both patients.

Conclusions: This reconstructive strategy for pancreaticoduodenectomy in gastrectomized patients, which uses either of the methods described above, has produced good results in our series of 7 patients and appears to be rational and straightforward.