Symptomatic Pancreaticojejunostomy Stricture After Pancreaticoduodenectomy: When Should Surgeons Operate?

BackgroundPancreaticojejunostomy stricture (PJS) is an uncommon late complication of pancreaticoduodenectomy (PD). Intervention is reserved for symptomatic strictures refractory to conservative treatment, but its indications and choice of procedure remain unclear.MethodsWe retrospectively reviewed 7 patients with symptomatic PJS who underwent reoperation at the Fifth Affiliated Hospital of Xinjiang Medical University (2019-2025).ResultsMedian age at initial PD was 51 years; chronic pancreatitis predominated (4/7). Median symptom interval after PD was 36 months; median main pancreatic duct diameter, 7 mm (range, 6-9.1). Manifestations were steatorrhea (7/7), recurrent pancreatitis (5/7), abdominal pain (3/7), and distension (3/7). Five underwent anastomotic resection and reconstruction; 2 had total pancreatectomy with splenectomy for severe fibrosis, infected necrosis, and splenic involvement. Six (85.7%) had sustained relief over a median 36-month follow-up; 1 required total pancreatectomy for duct stones. Pathology showed chronic inflammatory changes in all specimens; poorly differentiated ductal adenocarcinoma was found at the anastomosis in 1.ConclusionsIn patients with symptomatic PJS refractory to conservative treatment, symptom relief was obtained after reoperation and maintained through the last follow-up in 6 of 7; given the small sample and no control group, this is a descriptive observation. Decisions should integrate symptoms, imaging, and remnant pancreatic status, not the stricture alone. Reconstruction may be considered when the remnant pancreas is worth preserving and local conditions favorable; earlier total pancreatectomy may be appropriate with extensive atrophy, infected necrosis, splenic involvement, or failed reconstruction. Occult malignancy should be suspected with longstanding inflammation; all specimens require pathologic examination.