Surgical case reports · 2026
Pancreaticoduodenectomy after Laparoscopic Sleeve Gastrectomy with Preservation of Gastric Arterial Inflow: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Yoshioka Yuta, Kozuki Akihito, Shinzeki Makoto, Abe Koichiro, Omine Takumi, Tsuyu Naoto, Takahashi Keisuke, Nishikawa Taishi, Tokikuni Hiroko, Kaneda Kunihiko
Аннотация
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.
CONCLUSIONS: PD after an LSG is feasible, but careful vascular assessment, a preplanned reconstruction strategy, consideration of the patient's metabolic and nutritional status, and careful intraoperative assessment of the remnant stomach may enhance surgical safety.
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.
CONCLUSIONS: PD after an LSG is feasible, but careful vascular assessment, a preplanned reconstruction strategy, consideration of the patient's metabolic and nutritional status, and careful intraoperative assessment of the remnant stomach may enhance surgical safety.