Case SeriesPancreaticoduodenectomy following gastrectomy reconstructed with Billroth II or Roux-en-Y method: Case series and literature review

- The ideal reconstruction method for pancreaticoduodenectomy following a gastrectomy with Billroth II or Roux-en-Y is proposed.
- Half patients in whom the past afferent limb was used for the reconstruction of the pancreaticojejunostomy and hepaticojejunostomy experienced afferent loop syndrome.
- The Roux-en-Y method, using the distal intestine of previous gastrojejunostomy or jejunojejunostomy as a new jejunal limb for pancreaticojejunostomy and hepaticojejunostomy, may be a better reconstruction method to avoid afferent loop syndrome.

IntroductionThe ideal reconstruction method for pancreaticoduodenectomy following a gastrectomy with Billroth II or Roux-en-Y reconstruction is unclear. Methods: We reviewed a series of seven pancreaticoduodenectomies performed after gastrectomy with the Billroth II or Roux-en-Y method. Results: While preserving the existing gastrojejunostomy or esophagojejunostomy, pancreaticojejunostomy and hepaticojejunostomy were performed by the Roux-en-Y method using a new Roux limb in all cases. Four patients experienced postoperative complications, although the specific complications varied.DiscussionA review of the literature revealed 13 cases of pancreaticoduodenectomy following gastrectomy with Billroth II or Roux-en-Y reconstruction. Three patients out of six (50%) in whom the past afferent limb was used for the reconstruction of the pancreaticojejunostomy and hepaticojejunostomy experienced afferent loop syndrome, while 14 previous and current patients in whom a new jejeunal limb was used did not experience this complication.ConclusionThe Roux-en-Y method, using the distal intestine of previous gastrojejunostomy or jejunojejunostomy as a new jejunal limb for pancreaticojejunostomy and hepaticojejunostomy, may be a better reconstruction method to avoid the complication of afferent loop syndrome after previous gastrectomy with Billroth II or Roux-en-Y reconstruction if the afferent limb is less than 40 cm.