Biliary diversion Q-shape reconstruction after pancreaticoduodenectomy: Chang's reconstruction.

BACKGROUND/AIMS: This is a simple and easy reconstruction method designed for safely performing a pancreaticoduodenectomy (PD), even when it is complicated by a leakage from pancreaticojejunostomy (PJ).

METHODOLOGY: Five patients with periampullary malignancy underwent PD with biliary diversion Q-shaped reconstruction. An end-to-side anastomosed proximal jejunal loop (30 cm), divided by a gastrointestinal anastomosis (GIA) stapler at its top and reapproximated by intermittent serosal sutures, was used for a choledochojejunostomy and a PJ (fistulation, duct-to-mucosa, or end-to-side method) at each divided loop. Then gastrojejunostomy or duodenojejunostomy was made 30 cm distal to the jejunojejunostomy of the loop.

RESULTS

The clinic courses were surprisingly uneventful. There was no mortality. One patient showed a minor pancreatic leakage, one pylorus-preserving patient experienced a 25-day delay in gastric emptying, and another patient required second operation for intra-abdominal bleeding from a tiny branch of the superior mesenteric artery.

CONCLUSION

Biliary diversion Q-shaped PD is a safer reconstruction method for reducing lethal hemorrhagic crisis associated with PJ anastomotic leakage after PD.