Surgical case reports
Pancreaticoduodenectomy after Laparoscopic Sleeve Gastrectomy with Preservation of Gastric Arterial Inflow: A Case Report
By Yoshioka Y, Kozuki A, Shinzeki M and 7 others.
Abstract
Introduction
Obesity is an established risk factor for pancreatic ductal adenocarcinoma. As laparoscopic sleeve gastrectomy (LSG) has become increasingly prevalent, pancreatic surgeons may encounter malignancies in patients with a surgically altered gastric anatomy. Pancreaticoduodenectomy (PD) after an LSG is rare and requires meticulous preoperative planning to prevent ischemic and anastomotic complications.
Case presentation
A 47-year-old man with morbid obesity (BMI 59.1 kg/m2) underwent LSG. Twenty-three days later, obstructive jaundice led to the diagnosis of pancreatic head adenocarcinoma. After neoadjuvant chemotherapy and substantial weight reduction (BMI 34.9 kg/m2), subtotal stomach-preserving pancreaticoduodenectomy with wedge resection of the superior mesenteric vein was performed. Preoperative CT confirmed the preservation and patency of both the left and right gastric arteries. The left gastric artery was preserved intraoperatively. Gastrojejunostomy was performed using a hand-sewn anastomosis between the greater curvature side of the sleeve stomach and the jejunum. The patient developed a grade B postoperative pancreatic fistula but was discharged with no ischemic complications.