Preserve or Resect? A Novel Approach to Gastric Remnant Management During Pancreaticoduodenectomy in Post- Roux-en-Y Patients

Erin E. Grayhack, Christopher Sherry, Muhammad Muntazir Mehdi Khan, Edward Joseph, Patrick L Wagner, Manish Dhawan and Casey J Allen*

Allegheny Health Network Cancer Institute - 320 East North Ave, Pittsburgh, PA 15212, United States Allegheny Health Network, Center for Digestive Health - 1307 Federal St, Pittsburgh, PA 15212, United States

^*Correspondance to: Casey J Allen 

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Abstract:

The increasing prevalence of obesity and widespread adoption of Roux-en-Y gastric bypass (RYGB) pose unique challenges in the surgical management of complex gastrointestinal malignancies. RYGB alters foregut anatomy, complicating both diagnostic and therapeutic approaches. This case review highlights a 58-year-old female with duodenal adenocarcinoma in the context of prior RYGB and explores a novel strategy for pancreaticoduodenectomy reconstruction in such anatomically altered patients. Her workup revealed moderately differentiated mucinous adenocarcinoma of the duodenum (stage IIIB, cT4N2M0), and she ultimately underwent pancreaticoduodenectomy with a tailored reconstruction by anastomosing the blind remnant stomach to the native Roux limb as a safe and feasible approach. The patient subsequently developed obstruction of the biliopancreatic limb due to tumor recurrence, and the remnant stomach was accessed endoscopically to perform a palliative gastrointestinal bypass. Pancreaticoduodenectomy in post-RYGB patients requires innovative, patient-specific approaches to address altered anatomy and nutritional demands. This case underscores the importance of preoperative planning, tailored reconstruction strategies, and multidisciplinary collaboration. While current evidence does not favor a single superior technique, leveraging the Roux limb for reconstruction demonstrates feasibility and may enhance postoperative outcomes. Further studies are needed to optimize surgical management in this growing patient population.

Keywords:

Roux-en-Y gastric bypass, malignancy, foregut, pancreaticoduodenectomy, reconstruction, Roux limb, gastric remnant

Cite the Article:

Grayhack EE, Sherry C, Khan MMM, Joseph E, Wagner PL, Dhawan M, et al. Preserve or Resect? A Novel Approach to Gastric Remnant Management During Pancreaticoduodenectomy in Post-Roux-en-Y Patients. Ann Clin Case Rep. 2025; 10: 2799..