A Modified Procedure to Improve Pancreatic Drainage in Chronic Pancreatitis With Pancreatic Head Dominant Disease

Objectives: Chronic pancreatitis is a debilitating and progressive inflammatory disease with an altered quality of life due to severe abdominal pain. Pancreaticoduodenectomy is a surgical option for patients with bulky disease involving the head of the pancreas, especially when this disease has progressed to stricture of the bile duct, duodenum, or both. A long-term issue associated with this procedure is the stricture of the pancreatic anastomosis. Reoperative and endoscopic interventions are difficult related to difficulty in reaching the anastomosis endoscopically. We describe a variation of this procedure with the potential to lead to longer-term improvement in the drainage of the residual pancreas. Methods: We reviewed electronic medical records of patients undergoing pancreaticoduodenectomy for chronic pancreatitis performed by 1 surgeon at the University of Minnesota Medical Center, Minneapolis, MN, between 2014 and 2023. Information gathered from the patient's records included preoperative demographics, perioperative outcomes, and postoperative follow-up information. Results: The described procedure was performed on 8 patients between 2014 and 2023. Three patients have died since surgery at 1.5, 5.5, and 8 years postop, with no deaths related to pancreatitis or surgical complications. Of the remaining 5 patients, the median time from surgery is 7.5 years. Conclusions: We describe a surgical technique that may reduce the risk of pancreaticojejunal stricture in patients undergoing pancreaticoduodenectomy for chronic pancreatitis. In a small series of patients, this procedure can be performed safely with acceptable results.