Laparoscopic Gastrectomy with Roux-En-Y Anastomosis for Pediatric Duodenal Ulcer: A Case Report with 3-Year Follow-Up

While upper gastrointestinal ulcers are a common condition in adults, with well-established surgical approaches such as Billroth I, Billroth II, and Roux-en-Y (RY) reconstruction, their occurrence in the pediatric population is markedly less common and presents distinct diagnostic and management challenges. Consequently, surgical intervention for pediatric ulcers remains relatively infrequent and less studied. Although procedures like Billroth I, Billroth II, and RY are technically feasible options, there is a notable lack of robust evidence and specific guidelines to inform optimal surgical management strategies tailored specifically for children.

We report the treatment of a 13-year-old female patient with a duodenal bulbar ulcer leading to scar stenosis, who was managed with a laparoscopic subtotal gastrectomy and gastro-jejunal Roux-en-Y anastomosis. The patient demonstrated excellent growth and development over a three-year follow-up period, with no significant early or long-term complications.

Although severe complications of peptic ulcer disease (PUD) are uncommon in the pediatric population, gastric resection combined with Roux-en-Y anastomosis represents a safe and efficacious surgical strategy for refractory cases. In this report, we compare the Roux-en-Y procedure with other reconstructive methods, such as Billroth I and II, and discuss the indications and outcomes of various surgical therapies for upper gastrointestinal ulcers in children. We advocate for Roux-en-Y anastomosis as the preferred surgical method for treating complicated upper gastrointestinal ulcers in children, primarily due to its superior long-term outcomes in preventing bile reflux and residual gastritis.