Pancreaticojejuno-jejunostomy during reconstruction of the afferent loop in surgery of radiation-induced afferent loop obstruction following pancreaticoduodenectomy with Roux-en-Y reconstruction

被引：5

作者：

Blouhos K. ^{[1
]}

Boulas K.A. ^{[1
]}

Tsiomita E. ^{[1
]}

Papageorgiou I. ^{[1
]}

Ioannidis K. ^{[1
]}

Hatzigeorgiadis A. ^{[1
]}

机构：

[1] Department of General Surgery, General Hospital of Drama, 66100 Drama, End of Hippokratous Street

来源：

Updates in Surgery | 2014年 / 66卷 / 1期

关键词：

Afferent loop obstruction; Endoscopy; Pancreaticoduodenectomy; Radiation enteritis; Roux-en-Y reconstruction; Surgery;

D O I：

10.1007/s13304-013-0238-8

中图分类号：

学科分类号：

摘要：

Radiation-induced afferent loop obstruction is a rare complication following pancreaticoduodenectomy and adjuvant radiotherapy. As in the setting of Roux-en-Y reconstruction endoscopic approaches are limited, surgery of this complication becomes inevitable. This study provides a new classification/ management system of the radiation-induced obstruction of the afferent loop based on the extent and location of radiation injury, and describes the Pancreaticojejuno-jejunostomy, a novel technique to avoid revision of the pancreatic anastomosis during reconstruction of the afferent loop. Data were analyzed from nine patients who developed radiation-induced afferent loop obstruction after pancreaticoduodenectomy with single Roux limb reconstruction. One patient had type I obstruction and treated with by-pass surgery, seven patients had type II obstruction and treated with reconstruction including revision of the hepaticojejunostomy and Pancreaticojejuno-jejunostomy, and one patient had type III obstruction and treated with reconstruction including revision of the hepaticojejunostomy and the pancreatic anastomosis. Reconstruction along with Pancreaticojejuno-jejunostomy performed in six patients with type II radiation-induced afferent loop obstruction; reconstruction was not feasible for one patient. The median operative time was 149 min. No intraoperative complication was observed. By performing Pancreaticojejuno-jejunostomy we managed efficiently to convert a pancreatic anastomosis to an enteric anastomosis as one case of Grade B pancreatic fistula and no case of Pancreaticojejuno-jejunostomy stricture were observed, regarding short- and long-term results, respectively. The above technique may have a useful application in the surgical management of the radiation-induced afferent loop obstruction when endoscopy fails and by-pass surgery is inappropriate. © 2013 Springer-Verlag Italia.

引用

页码：51 / 57

页数：6

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