Hybrid surgical approach for chronic pancreatitis: pyloric-ring-resection pancreaticoduodenectomy with lateral pancreatojejunostomy

Pancreaticoduodenectomy (PD) and lateral pancreatojejunostomy are established surgical techniques for treating chronic pancreatitis (CP), but their combination has not been studied. We performed PD combined with lateral pancreatojejunostomy in 15 patients with morphological changes consistent with CP. Preoperative imaging revealed features of CP confined to the head of the pancreas (HOP) and main pancreatic duct (MPD) dilation with strictures and stones in all but one patient. Surgical procedures were completed successfully in all the patients. One patient (6.6%) developed major complications that required reoperation. There was no 90-day mortality. At follow-up (median, 66 months), pain, quality of life, and exocrine function had improved, whereas endocrine function worsened in 4 of the 7 non-insulin-dependent diabetic patients, requiring insulin therapy. This hybrid approach provided durable pain relief, improved quality of life, and stabilized exocrine function. Endocrine deterioration in some cases highlights the challenges of managing pre-existing pancreatic insufficiency.