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

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.