Effects of preceding gastrectomy on the outcome of pancreatoduodenectomy.

It is a complicated task to perform pancreatoduodenectomy for patients who previously had undergone gastrectomy. This paper reviewed our experience of eight pancreatoduodenectomies in gastrectomized patients. The indications for gastrectomy included gastric cancer in 3 patients, duodenal ulcer in 1 patient, and gastric ulcer in 4 patients. The interval between the two operations ranged from 15-254 months (average: 103 months). All patients underwent pancreatoduodenectomy, and the reconstruction after pancreatoduodenectomy was performed by the Whipple method, the Child method, or other complex Roux-en-Y type methods. All the patients recovered and were discharged without gastrointestinal disorder. The results suggest that the secondary pancreatoduodenectomy does not increase the mortality rate, although we should use the jejunal limb with less tissue damage at the anastomotic site of which circulation is well maintained for choledochojejunostomy and pancreaticojejunostomy. Furthermore, the jejunal limb should be lined carefully to avoid intestinal kinking and excess tension to the anastomosis.