Skip to main content

Advertisement

SpringerLink
Log in

Gastroduodenal and pancreatic surgeries: indications, surgical techniques, and imaging features

  • Pictorial Essay
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

This review article focuses on gastroduodenal and pancreatic surgeries with the goal of identifying radiologic findings that translate to important surgical considerations. The topics covered include partial gastrectomy with reconstruction techniques, total gastrectomy, pancreaticoduodenectomy, and pancreaticojejunostomy. Indications, contraindications, surgical techniques, and postoperative imaging are described within each of these topics. Knowledge of these surgical techniques is extremely helpful for the interpreting radiologists to identify expected postoperative anatomy and related complications that would remain clinically relevant to our surgical colleagues and direct timely patient management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23

Similar content being viewed by others

References

  1. Carucci LR, Turner MA, Conklin RC, et al. (2006) Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series. Radiology 238(1):119–127

    Article  PubMed  Google Scholar 

  2. Alley JB (2017) Comment on: trends in utilization of bariatric surgery, 2010–2014: sleeve gastrectomy dominates. Surg Obes Relat Dis. doi:10.1016/j.soard.2017.01.037

    PubMed  Google Scholar 

  3. Sakran N, Goitein D, Raziel A, et al. (2013) Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 27(1):240–245

    Article  PubMed  Google Scholar 

  4. Picone D, Rusignuolo R, Midiri F, et al. (2016) Imaging assessment of gastroduodenal perforations. Semin Ultrasound CT MR 37(1):16–22

    Article  PubMed  Google Scholar 

  5. Katai H (2006) Function-preserving surgery for gastric cancer. Int J Clin Oncol 11(5):357–366

    Article  PubMed  Google Scholar 

  6. do Park J, Lee HJ, Jung HC, et al. (2008) Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg 32(6):1029–1036

    Article  PubMed  Google Scholar 

  7. Ishikawa K, Arita T, Ninomiya S, et al. (2007) Outcome of segmental gastrectomy versus distal gastrectomy for early gastric cancer. World J Surg 31(11):2204–2207

    Article  PubMed  Google Scholar 

  8. Ando S, Tsuji H (2008) Surgical technique of vagus nerve-preserving gastrectomy with D2 lymphadenectomy for gastric cancer. ANZ J Surg 78(3):172–176

    Article  PubMed  Google Scholar 

  9. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11(5):439–449

    Article  PubMed  Google Scholar 

  10. ReMine WH (1979) Indications and contraindications for surgery in gastric carcinoma. World J Surg 3(6):709–714

    Article  CAS  PubMed  Google Scholar 

  11. Edil BMM, Gajdos C, Schulick RD (2014) Periampullary Carcinoma. In: Cameron JLCA (ed) Current surgical therapy, 11th edn. Philadelphia: Elsevier Saunders, pp 471–477

    Google Scholar 

  12. Takeuchi H, Goto O, Yahagi N, Kitagawa Y (2017) Function-preserving gastrectomy based on the sentinel node concept in early gastric cancer. Gastric Cancer 20(Suppl 1):53–59

    Article  PubMed  Google Scholar 

  13. Yang HKKS (2014) Laparoscopic gastric surgery. In: Cameron JLCA (ed) Current surgical therapy, 11th edn. Philadelphia: Elsevier, pp 1349–1363

    Google Scholar 

  14. Gaetke-Udager K, Wasnik AP, Kaza RK, et al. (2014) A guide to imaging in bariatric surgery. Emerg Radiol 21(3):309–319

    Article  PubMed  Google Scholar 

  15. Steele KE, Prokopowicz GP, Magnuson T, Lidor A, Schweitzer M (2008) Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc 22(9):2056–2061

    Article  CAS  PubMed  Google Scholar 

  16. Ikramuddin S, Kendrick ML, Kellogg TA, Sarr MG (2007) Open and laparoscopic Roux-en-Y gastric bypass: our techniques. J Gastrointest Surg 11(2):217–228

    Article  PubMed  Google Scholar 

  17. Zong L, Chen P (2011) Billroth I vs. Billroth II vs. Roux-en-Y following distal gastrectomy: a meta-analysis based on 15 studies. Hepato-Gastroenterology 58(109):1413–1424

    PubMed  Google Scholar 

  18. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA (2007) Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg 245(2):254–258

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mbadiwe T, Prevatt E, Duerinckx A, et al. (2015) Assessing the value of routine upper gastrointestinal contrast studies following bariatric surgery: a systematic review and meta-analysis. Am J Surg 209(4):616–622

    Article  PubMed  Google Scholar 

  20. Bingham J, Shawhan R, Parker R, Wigboldy J, Sohn V (2015) Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery. Am J Surg 209(5):810–814 (discussion 814)

    Article  PubMed  Google Scholar 

  21. Kim J, Azagury D, Eisenberg D, et al. (2015) ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Related Dis 11(4):739–748

    Article  Google Scholar 

  22. Hirao M, Takiguchi S, Imamura H, et al. (2013) Comparison of Billroth I and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol 20(5):1591–1597

    Article  PubMed  Google Scholar 

  23. Tsuei BJ, Schwartz RW (2004) Management of the difficult duodenum. Curr Surg 61(2):166–171

    Article  PubMed  Google Scholar 

  24. Degiuli M, Sasako M, Ponti A, et al. (1998) Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study. J Clin Oncol 16(4):1490–1493

    Article  CAS  PubMed  Google Scholar 

  25. Shao QS, Wang YX, Ye ZY, Zhao ZK, Xu J (2011) Application of purse-string suture for management of duodenal stump in radical gastrectomy. Chin Med J (Engl) 124(7):1018–1021

    Google Scholar 

  26. Jex RK, van Heerden JA, Wolff BG, Ready RL, Ilstrup DM (1987) Gastrointestinal anastomoses. Factors affecting early complications. Ann Surg 206(2):138–141

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hermann RE (1973) T tube catheter drainage of the duodenal stump. Am J Surg 125(3):364–366

    Article  CAS  PubMed  Google Scholar 

  28. Rijcken E, Sachs L, Fuchs T, Spiegel HU, Neumann PA (2014) Growth factors and gastrointestinal anastomotic healing. J Surg Res 187(1):202–210

    Article  CAS  PubMed  Google Scholar 

  29. Gayer G, Barsuk D, Hertz M, Apter S, Zissin R (2002) CT diagnosis of afferent loop syndrome. Clin Radiol 57(9):835–839

    Article  CAS  PubMed  Google Scholar 

  30. Zissin R (2004) CT findings of afferent loop syndrome after a subtotal gastrectomy with Roux-en-Y reconstruction. Emerg Radiol 10(4):201–203

    Article  PubMed  Google Scholar 

  31. Fischer J, Fegelman E, Johannigman J: Surgical complications. In: Principles of surgery. 7 edn. Edited by al Se. New York, USA: McGraw-Hill; 1999, pp. 441–484.

  32. Nguyen NT, Goldman C, Rosenquist CJ, et al. (2001) Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 234(3):279–289 (discussion 289–291)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Higa KD, Boone KB, Ho T (2000) Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients–what have we learned? Obes Surg 10(6):509–513

    Article  CAS  PubMed  Google Scholar 

  34. Kassir R, Debs T, Blanc P, et al. (2016) Complications of bariatric surgery: presentation and emergency management. Int J Surg 27:77–81

    Article  PubMed  Google Scholar 

  35. Zurita Mv LC, Tabari M, Hong D (2013) Laparoscopic conversion of laparoscopic Roux-en-Y gastric bypass to laparoscopic sleeve gastrectomy for intractable dumping syndrome and excessive weight loss. Surg Obes Related Dis 9(2):e34–37

    Article  Google Scholar 

  36. Higa KD, Ho T, Boone KB (2003) Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 13(3):350–354

    Article  PubMed  Google Scholar 

  37. Meyers MACC, Oliphant M (2011) Internal abdominal hernias, 6th edn. New York: Springer

    Google Scholar 

  38. Balthazar EJ, Birnbaum BA, Megibow AJ, et al. (1992) Closed-loop and strangulating intestinal obstruction: CT signs. Radiology 185(3):769–775

    Article  CAS  PubMed  Google Scholar 

  39. Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane Database Syst Rev 8:CD003641

    Google Scholar 

  40. Lager CJ, Esfandiari NH, Subauste AR, et al. (2017) Roux-En-Y GASTRIC bypass Vs. Sleeve gastrectomy: balancing the risks of surgery with the benefits of weight loss. Obes Surg 27(1):154–161

    Article  PubMed  Google Scholar 

  41. Fuks D, Verhaeghe P, Brehant O, et al. (2009) Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 145(1):106–113

    Article  PubMed  Google Scholar 

  42. Baker RS, Foote J, Kemmeter P, et al. (2004) The science of stapling and leaks. Obes Surg 14(10):1290–1298

    Article  PubMed  Google Scholar 

  43. Chivot C, Rebibo L, Robert B, et al. (2017) Value of routine upper gastrointestinal swallow study after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. doi:10.1016/j.soard.2017.02.003

    Google Scholar 

  44. Rebibo L, Hakim S, Dhahri A, et al. (2016) Gastric stenosis after laparoscopic sleeve gastrectomy: diagnosis and management. Obes Surg 26(5):995–1001

    Article  PubMed  Google Scholar 

  45. Burgos AM, Csendes A, Braghetto I (2013) Gastric stenosis after laparoscopic sleeve gastrectomy in morbidly obese patients. Obes Surg 23(9):1481–1486

    Article  PubMed  Google Scholar 

  46. Sarkhosh K, Birch DW, Sharma A, Karmali S (2013) Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Can J Surg 56(5):347–352

    Article  PubMed  PubMed Central  Google Scholar 

  47. Zanaboni A (1977) Total gastrectomy: indications, surgical technics, complications and results. Minerva Med 68(5):311–318

    CAS  PubMed  Google Scholar 

  48. Lehnert T, Buhl K (2004) Techniques of reconstruction after total gastrectomy for cancer. Br J Surg 91(5):528–539

    Article  CAS  PubMed  Google Scholar 

  49. Hunt CJ (1952) Construction of food pouch from segment of jejunum as substitute for stomach in total gastrectomy. AMA Arch Surg 64(5):601–608

    Article  CAS  PubMed  Google Scholar 

  50. Levine MS, Fisher AR, Rubesin SE, et al. (1991) Complications after total gastrectomy and esophagojejunostomy: radiologic evaluation. AJR Am J Roentgenol 157(6):1189–1194

    Article  CAS  PubMed  Google Scholar 

  51. Whipple AO (1945) Pancreaticoduodenectomy for Islet Carcinoma: a five-year follow-up. Ann Surg 121(6):847–852

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Ho CK, Kleeff J, Friess H, Buchler MW (2005) Complications of pancreatic surgery. HPB (Oxford) 7(2):99–108

    Article  PubMed Central  Google Scholar 

  53. Al-Hawary MM, Kaza RK, Francis IR (2016) Optimal imaging modalities for the diagnosis and staging of periampullary masses. Surg Oncol Clin N Am 25(2):239–253

    Article  PubMed  Google Scholar 

  54. Al-Hawary MM, Kaza RK, Wasnik AP, Francis IR (2013) Staging of pancreatic cancer: role of imaging. Semin Roentgenol 48(3):245–252

    Article  PubMed  Google Scholar 

  55. Diener MK, Fitzmaurice C, Schwarzer G, et al. (2014) Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev. doi:10.1002/14651858.CD006053.pub5

    PubMed  PubMed Central  Google Scholar 

  56. Diener MK, Fitzmaurice C, Schwarzer G, et al. (2011) Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev. doi:10.1002/14651858.CD006053.pub4

    Google Scholar 

  57. Cordesmeyer S, Lodde S, Zeden K, Kabar I, Hoffmann MW (2014) Prevention of delayed gastric emptying after pylorus-preserving pancreatoduodenectomy with antecolic reconstruction, a long jejunal loop, and a jejuno-jejunostomy. J Gastroint Surg 18(4):662–673

    Article  CAS  Google Scholar 

  58. Kurahara H, Shinchi H, Maemura K, et al. (2011) Delayed gastric emptying after pancreatoduodenectomy. J Surg Res 171(2):e187–192

    Article  PubMed  Google Scholar 

  59. Perwaiz A, Singhal D, Singh A, Chaudhary A (2009) Is isolated Roux loop pancreaticojejunostomy superior to conventional reconstruction in pancreaticoduodenectomy? HPB (Oxford) 11(4):326–331

    Article  Google Scholar 

  60. Shimoda M, Kubota K, Katoh M, Kita J (2013) Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study. Ann Surg 257(5):938–942

    Article  PubMed  Google Scholar 

  61. Soriano A, Castells A, Ayuso C, et al. (2004) Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol 99(3):492–501

    Article  PubMed  Google Scholar 

  62. Ichikawa T, Haradome H, Hachiya J, et al. (1997) Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging. Radiology 202(3):655–662

    Article  CAS  PubMed  Google Scholar 

  63. Yang MJ, Li S, Liu YG, Jiao N, Gong JS (2013) Common and unusual CT and MRI manifestations of pancreatic adenocarcinoma: a pictorial review. Quant Imaging Med Surg 3(2):113–120

    PubMed  PubMed Central  Google Scholar 

  64. NCCN Practice Guidlines for Pancreatic Cancer, Version 1. 2017 (https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf). Accessed 11 Apr, 2017.

  65. Al-Hawary MM, Francis IR, Chari ST, et al. (2014) Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology 270(1):248–260

    Article  PubMed  Google Scholar 

  66. Raman SP, Horton KM, Cameron JL, Fishman EK (2013) CT after pancreaticoduodenectomy: spectrum of normal findings and complications. AJR Am J Roentgenol 201(1):2–13

    Article  PubMed  Google Scholar 

  67. Saraee A, Vahedian-Ardakani J, Saraee E, Pakzad R, Wadji MB (2015) Whipple procedure: a review of a 7-year clinical experience in a referral center for hepatobiliary and pancreas diseases. World J Surg Oncol 13:98

    Article  PubMed  PubMed Central  Google Scholar 

  68. Helmink BA, Snyder RA, Idrees K, Merchant NB, Parikh AA (2016) Advances in the surgical management of resectable and borderline resectable pancreas cancer. Surg Oncol Clin N Am 25(2):287–310

    Article  PubMed  Google Scholar 

  69. LeBedis CA, Bates DD, Soto JA (2016) Iatrogenic, blunt and penetrating trauma to the biliary tract. Abdom Radiol 42(1):28–45

    Article  Google Scholar 

  70. Young SA, Sfakianakis GN, Pyrsopoulos N, Nishida S (2003) Hepatobiliary scintigraphy in liver transplant patients: the “blind end sign” and its differentiation from bile leak. Clin Nucl Med 28(8):638–642

    PubMed  Google Scholar 

  71. Cahen DL, Gouma DJ, Nio Y, et al. (2007) Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 356(7):676–684

    Article  CAS  PubMed  Google Scholar 

  72. Puestow CB, Gillesby WJ (1958) Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 76(6):898–907

    Article  CAS  PubMed  Google Scholar 

  73. Partington PF, Rochelle RE (1960) Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 152:1037–1043

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Ceppa EP, Pappas TN (2009) Modified puestow lateral pancreaticojejunostomy. J Gastroint Surg 13(5):1004–1008

    Article  Google Scholar 

  75. Riediger H, Adam U, Fischer E, et al. (2007) Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastroint Surg 11(8):949–959 (discussion 959–960)

    Article  Google Scholar 

Download references

Acknowledgements

All illustrations used in the manuscript are original work and authors thank and acknowledge Danielle Dobbs and Vanessa Allen from Media Division of Radiology Department, University of Michigan Health System.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA

    Nishant A. Patel, Katherine E. Maturen, Mahmoud M. Al-Hawary, Ravi K. Kaza & Ashish P. Wasnik

  2. Department of Surgery, University of Michigan Health Systems, 1500 East Medical Center Dr, Ann Arbor, MI, 48109, USA

    Scott E. Regenbogen

Authors
  1. Nishant A. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine E. Maturen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott E. Regenbogen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mahmoud M. Al-Hawary
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ravi K. Kaza
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ashish P. Wasnik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashish P. Wasnik.

Ethics declarations

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

The study was approved by the Institutional Review board. Given retrospective review, informed consent was waived by the Institutional Review board for this study.

Additional information

CME activity

This article has been selected as the CME activity for the current month. Please visit https://ce.mayo.edu/node/45064 and follow the instructions to complete this CME activity.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Patel, N.A., Maturen, K.E., Regenbogen, S.E. et al. Gastroduodenal and pancreatic surgeries: indications, surgical techniques, and imaging features. Abdom Radiol 42, 2054–2068 (2017). https://doi.org/10.1007/s00261-017-1165-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-017-1165-9

Keywords

Search

Navigation