Longitudinal Pancreaticojejunostomy Reconstruction Following Pancreaticoduodenectomy for Patients With Concomitant Chronic Pancreatitis - How I Do It

Sep 28, 2026

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Surgical management of pancreatic head lesions complicated by chronic pancreatitis requires effective pancreatic duct drainage after resection. The report presents a detailed technique for longitudinal pancreaticojejunostomy (LPJ) reconstruction following pancreaticoduodenectomy (PD) in patients with concomitant chronic pancreatitis. The method targets wide-area drainage via a side-to-side anastomosis between an extensively opened pancreatic duct and jejunum, adapted from established drainage concepts. Meticulous pancreatic exposure, adequate longitudinal incision, and precise anastomosis are emphasized, with successful outcomes in three cases.

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Annals of Gastroenterological Surgery HOW I DO IT OPEN ACCESS Longitudinal Pancreaticojejunostomy Reconstruction Following Pancreaticoduodenectomy for Patients With Concomitant Chronic Pancreatitis: How I Do It Hideaki Sato | Masaharu Ishida | Naoki Rikiyama | Masamichi Mizuma | Michiaki Unno Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan Correspondence: Michiaki Unno ([michiaki.unno.e5@tohoku.ac.jp](michiaki.unno.e5@tohoku.ac.jp)) Received: 25 July 2025 | Revised: 1 September 2025 | Accepted: 16 September 2025 Funding: The authors received no specific funding for this work. Keywords: chronic pancreatitis | lateral pancreaticojejunostomy | longitudinal pancreaticojejunostomy | pancreaticoduodenectomy ABSTRACT Surgical management of pancreatic head lesions complicated by chronic pancreatitis (CP) presents significant challenges, particularly in ensuring effective pancreatic duct drainage after resection. This report describes the detailed technique and key considerations for longitudinal pancreaticojejunostomy (LPJ) as a reconstructive method following pancreaticoduodenectomy (PD) in patients with CP. This approach aims to achieve wide-area drainage of the remnant pancreatic duct through a side-to-side anastomosis between the extensively opened pancreatic duct and jejunum. Conceptually derived from conventional drainage procedures such as the Frey and Partington procedures, this technique is particularly beneficial when significant ductal dilatation persists distal to the resection margin. Critical steps for successful LPJ include meticulous exposure of the pancreatic parenchyma, an adequate longitudinal incision of the main pancreatic duct, and precise anastomotic technique. We have successfully applied this procedure in three male patients (median age 68 years, range: 48–77), including one with CP complicated by duodenal bleeding and two with pancreatic head region malignancies complicated with CP. All patients had favorable postoperative outcomes with no clinically relevant postoperative pancreatic fistula (Grade B or C) . Long-term follow-up showed significant symptom improvement without medication, and pancreatic function were relatively well preserved. Our preliminary experience suggests that LPJ provides safe and effective drainage of the pancreas following PD in patients with CP-complicated pancreatic head pathology and may represent a valuable reconstructive option, particularly in cases with marked pancreatic duct dilatation. 1 | Introduction The primary objectives of surgical management for chronic pancreatitis (CP) are to relieve intractable abdominal pain, manage exocrine and endocrine insufficiency, and prevent disease-related complications [1] . Surgical strategies are generally categorized into two main approaches, each based on distinct therapeutic principles: pancreatic duct drainage and pancreatic resection. Drainage procedures include pancreatojejunostomy with distal pancreatectomy (the Puestow procedure) [2], longitudinal pancreaticojejunostomy (LPJ), also known as the Partington procedure [3] . While resectional procedures comprise distal pancreatectomy (DP), pancreatoduodenectomy (PD), and duodenum-preserving pancreatic head resection (the Beger procedure) [4]. The Frey procedure, a LPJ with coring-out of the pancreatic head, theoretically combines elements of both drainage and resection, and is also commonly employed [5, 6] . The optimal surgical strategy for CP is determined by the patient's anatomical and pathological features. In cases involving extensive pancreatic head disease, particularly with duodenal involvement or concomitant malignancy, PD is often indicated. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Annals of Gastroenterological Surgery pub

FAQs

Why is duct drainage difficult in pancreatic head lesions complicated by chronic pancreatitis after resection?

The main challenge is ensuring effective pancreatic duct drainage after pancreatic head resection, since adequate decompression of the remnant duct is critical for symptom control and postoperative outcomes.

What is the core idea behind longitudinal pancreaticojejunostomy (LPJ) after pancreaticoduodenectomy?

LPJ aims to achieve wide-area drainage of the remnant pancreatic duct through a side-to-side anastomosis between a longitudinally opened pancreatic duct and the jejunum.

What key technical steps are considered essential for successful LPJ reconstruction?

Successful LPJ requires meticulous exposure of the pancreatic parenchyma, an adequate longitudinal incision of the main pancreatic duct, and a precise anastomotic technique.

Sep 28, 2026

Uploaded by dabgoudw