Videolaparoscopic pancreatojejunostomy using a hybrid technique in chronic pancreatitis without significant ductal dilatation

04/09/2026

AI Summary

Hybrid laparoscopic pancreatojejunostomy combining Izbicki V-shaped parenchymal excision with longitudinal Partington-Rochelle anastomosis offers effective decompression in small duct disease.
The procedure is feasible laparoscopically with uneventful recovery: oral intake day 3, discharge day 5, and complete pain relief at six months.
Functional benefits included 20% reduced insulin requirement and improved exocrine control, indicating metabolic and symptomatic gains beyond pain relief.

Arq Bras Cir Dig. 2026 Aug 31;39:e1963. doi: 10.1590/0102-672020260000034e1963. eCollection 2026.

ABSTRACT

BACKGROUND: Chronic pancreatitis without significant main duct dilation is difficult to treat, as classic drainage procedures are less effective. Endoscopic therapy is often limited by complex anatomy, multiple strictures, stones, and the need for repeated procedures, frequently providing incomplete pain relief. Surgery offers better long-term pain control, but small-duct disease requires alternative strategies.

AIMS: To record the case of a 52-year-old man with alcoholic chronic pancreatitis who had progressive abdominal pain requiring opioids. Imaging showed a mildly dilated (6 mm), tortuous pancreatic duct with segmental strictures and a peripancreatic cystic lesion.

METHODS: Endoscopic treatment was considered suboptimal, and surgery was indicated. A hybrid laparoscopic pancreaticojejunostomy was performed, combining Izbicki’s V-shaped parenchymal excision with a longitudinal Partington-Rochelle anastomosis. The goal was to achieve effective decompression despite the small duct diameter, while preserving a minimally invasive approach.

RESULTS: Recovery was uneventful. Oral intake was resumed on the third postoperative day, and discharge occurred on the fifth. At six months, the patient had complete pain relief, a 20% reduction in insulin requirement, and improved control of exocrine insufficiency.

CONCLUSIONS: This hybrid laparoscopic technique is feasible and may be an effective alternative for patients with chronic pancreatitis and small-duct disease when standard procedures are unsuitable.

PMID:42690307 | DOI:10.1590/0102-672020260000034e1963

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