|
Back to 2014 Annual Meeting Posters
Reconstruction After Partial (D2/D3) Duodenectomy Using a Roux-en-Y Lateral Duodenojejunostomy: a Single Center Restrospective Analysis
Sumana Narayanan*1, Daniela Gomez1, Laleh Melstrom1,2, David a. August1,2, Darren R. Carpizo1,2
1Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 2Surgical Oncology, Cancer Institute of New Jersey, New Brunswick, NJ
Introduction: Oncologic resections of the D2 or D3 portions of the duodenum that require partial duodenectomy of the anti-mesenteric side can pose a challenging clinical problem. The surgical options include pancreaticoduodenectomy which carries significant morbidity and mortality versus partial duodenectomy that spares the head of the pancreas. In these latter cases the duodenum must be either repaired primarily or reconstructed. Primary repair is often not possible due to loss of extensive portions of the duodenum. Because these types of resections are not common there is a paucity of literature describing methods of reconstruction and their results. We have adopted a method of reconstruction using a Roux-en-Y limb of jejunum to construct a lateral duodenojejunostomy. We sought to report our results in a series of these cases.
Methods: Retrospective review of patients that underwent partial duodenectomy with Roux-en-Y reconstructions performed between April 1999 and June 2013 by three oncologic surgeons.
Results: Seven patients underwent partial duodenectomy with Roux-en-Y reconstruction. Of these, 3 were males and 4 females with a mean age of 65. Overall, the patients were relatively mal-nourished with a mean perioperative albumin of 3.0. Of the 7 patients, 4 had resection for tumors extrinsic to the duodenum (2 gastric and 2 colonic adenocarcinoma). Three had resections for tumors intrinsic to the duodenum (1 duodenal tubular adenoma and 2 with duodenal adenocarcinoma). One patient with duodenal cancer was resected via this approach because of endoscopic perforation and severe adjacent inflammation. 5 patients were reconstructed via retrocolic Roux-en-Y 2 layer handsewn duodenojejunostomy (D-J) with a 60-70 cm roux limb and 2 via antecolic D-J due to concurrent esophagojejunostomy. Mean estimated blood loss (EBL) was 671mL with a median operative time of 316 minutes. Post-op complications included 2 intra-abdominal abscesses (1 anastomotic leak) and 1 liver abscess. There were no complications related to injury to the Ampulla of Vater and no mortalities in the post-operative period.
Discussion: In this study we examined cases of patients that underwent partial resection of the anti-mesenteric side of the D2/D3 portions of the duodenum and were reconstructed using a Roux-en-Y duodenojejunostomy. These patients had a variety of pathologic diagnoses and underwent this operation for tumors both extrinsic and intrinsic to the duodenum. When resecting these tumors we always identified the Ampulla of Vater to ensure a safe resection. We found that in cases in which primary repair would compromise the duodenal lumen (resection of more than 1/3 to 1/2 the duodenum), Roux-en-Y reconstruction with a jejunal limb was safe and effective. Our rate of infectious complications was high and may be related to a population of advanced cancer patients.
Back to 2014 Annual Meeting Posters
|
