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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)76-87
Number of pages12
JournalJournal of Gastrointestinal Surgery
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2020

Fingerprint

Gastric Bypass
Anatomy
Propensity Score
Pancreaticoduodenectomy
Stomach
Extremities
Gastric Stump
Jejunostomy
Pancreatectomy
Gastrostomy
Obesity
Demography
Morbidity
Surgeons

Keywords

  • Bariatric surgery
  • Gastric bypass
  • Obesity
  • Pancreatoduodenectomy
  • Roux-en-Y
  • Whipple

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Pancreatic Head Resection Following Roux-en-Y Gastric Bypass : Operative Considerations and Outcomes. / the Pancreatic Head Resection after Roux-en-Y Gastric Bypass Study Group.

In: Journal of Gastrointestinal Surgery, Vol. 24, No. 1, 01.01.2020, p. 76-87.

Research output: Contribution to journalArticle

the Pancreatic Head Resection after Roux-en-Y Gastric Bypass Study Group. / Pancreatic Head Resection Following Roux-en-Y Gastric Bypass : Operative Considerations and Outcomes. In: Journal of Gastrointestinal Surgery. 2020 ; Vol. 24, No. 1. pp. 76-87.
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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.",
keywords = "Bariatric surgery, Gastric bypass, Obesity, Pancreatoduodenectomy, Roux-en-Y, Whipple",
author = "{the Pancreatic Head Resection after Roux-en-Y Gastric Bypass Study Group} and Trudeau, {M. T.} and L. Maggino and Ecker, {B. L.} and Vollmer, {C. M.} and Allendorf, {John D.} and Ball, {Chad G.} and Jordan Baechle and Behrman, {Stephen W.} and Carlos Chan and Corvera, {Carlos U.} and Cioffi, {Jessica L.} and Jash Datta and Dillhoff, {Mary E.} and Flick, {Katelyn F.} and Gumbs, {Andrew A.} and Grochola, {Lukasz Filip} and Kamran Idrees and Jajja, {Mohammad Raheel} and Kooby, {David A.} and Kruse, {Edward J.} and Lowy, {Andrew M.} and Moskowitz, {Barbara A.} and Maxwell, {Daniel L.} and Morris-Stiff, {Gareth J.} and Morgan, {Katherine A.} and O’Connor, {Victoria V.} and June Peng and Schrope, {Beth A.} and Sanford, {Dominic E.} and Sulzer, {Jesse K.} and Sarmiento, {Juan M.} and Mazhar Soufi and Smith, {Paula M.} and Perry Shen and Simpson, {Rachel E.} and Thompson, {Lee W.} and Valeria Vilchez and Vrochides, {Dionisios V.} and Wisneski, {Andrew D.} and Wray, {Curtis J.} and Winslow, {Emily R.} and Williams, {Gregory A.} and Zaydfudim, {Victor M.}",
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T1 - Pancreatic Head Resection Following Roux-en-Y Gastric Bypass

T2 - Operative Considerations and Outcomes

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

AU - Trudeau, M. T.

AU - Maggino, L.

AU - Ecker, B. L.

AU - Vollmer, C. M.

AU - Allendorf, John D.

AU - Ball, Chad G.

AU - Baechle, Jordan

AU - Behrman, Stephen W.

AU - Chan, Carlos

AU - Corvera, Carlos U.

AU - Cioffi, Jessica L.

AU - Datta, Jash

AU - Dillhoff, Mary E.

AU - Flick, Katelyn F.

AU - Gumbs, Andrew A.

AU - Grochola, Lukasz Filip

AU - Idrees, Kamran

AU - Jajja, Mohammad Raheel

AU - Kooby, David A.

AU - Kruse, Edward J.

AU - Lowy, Andrew M.

AU - Moskowitz, Barbara A.

AU - Maxwell, Daniel L.

AU - Morris-Stiff, Gareth J.

AU - Morgan, Katherine A.

AU - O’Connor, Victoria V.

AU - Peng, June

AU - Schrope, Beth A.

AU - Sanford, Dominic E.

AU - Sulzer, Jesse K.

AU - Sarmiento, Juan M.

AU - Soufi, Mazhar

AU - Smith, Paula M.

AU - Shen, Perry

AU - Simpson, Rachel E.

AU - Thompson, Lee W.

AU - Vilchez, Valeria

AU - Vrochides, Dionisios V.

AU - Wisneski, Andrew D.

AU - Wray, Curtis J.

AU - Winslow, Emily R.

AU - Williams, Gregory A.

AU - Zaydfudim, Victor M.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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.

AB - 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.

KW - Bariatric surgery

KW - Gastric bypass

KW - Obesity

KW - Pancreatoduodenectomy

KW - Roux-en-Y

KW - Whipple

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