Pancreaticoduodenectomy After Bariatric Surgery: Challenges and Available Techniques for Reconstruction

Introduction: Obesity is an epidemic in the USA, with approximately 7 % of the population considered morbidly obese (BMI > 40 or >35 with significant comorbidities). Discussion: Weight loss surgery is recognized as a durable solution to both obesity and obesity-associated morbidities. With an increasing number of pancreatic lesions being discovered on cross-sectional imaging, the pancreatic surgeon is increasingly likely to encounter patients with prior bariatric surgery who are in need of pancreaticoduodenectomy. As such, surgeons need to be familiar with the various bariatric operations, as well as the manner in which to handle prior bariatric reconstructions at the time of pancreatic surgery. Literature on this topic, however, is scarce with only a handful of small case series. Conclusion: We herein review the different operations performed for weight loss, as well as provide an overview of the available operative approaches for reconstruction after pancreaticoduodenectomy in postbariatric surgical patients.