Abstract
Bypass surgery for cancer of the pancreatic head is usually done to palliate the obstructive symptoms in the biliary and/or digestive system. However, it is uncommon for patients to require pancreatic duct drainage for recurrent obstructive pancreatitis. In this article, we report a surgical technique of triple bypass consisting of Roux-en-Y hepaticojejunostomy, gastrojejunostomy, and pancreaticojejunostomy for advanced pancreatic cancer. A 76-year-old male patient with locally advanced and metastatic pancreatic head cancer was referred to our department for biliary stricture, duodenal stenosis, and recurrent obstructive pancreatitis associated with persistent pancreatic pseudocyst. In an attempt to resolve all these problems simultaneously, a triple bypass was performed. The patient survived and continued to receive chemotherapy for almost 1 year after surgery without any serious complications. Thus, triple bypass is a useful surgical technique that could relief symptoms and offer better quality of life to patients with advanced pancreatic cancer presenting with biliary stricture, duodenal stenosis, and severe obstructive pancreatitis difficult to treat by medication or endoscopic procedures.
Highlights
Despite an increasing incidence of pancreatic cancer worldwide, the vast majority of patients with pancreatic cancer are diagnosed at an unresectable stage
A recent study has shown that the rate of patients with pancreatic cancer presenting with symptomatic duodenal obstruction has increased [1]
We report a surgical technique of triple bypass consisting of Roux-en-Y hepaticojejunostomy, gastrojejunostomy, and pancreaticojejunostomy
Summary
Despite an increasing incidence of pancreatic cancer worldwide, the vast majority of patients with pancreatic cancer are diagnosed at an unresectable stage. With new advances in multimodal therapy and resulting increment in the life expectancy of pancreatic cancer, the number of patients with obstructive symptoms of the biliary and gastrointestinal tract could increase. A recent study has shown that the rate of patients with pancreatic cancer presenting with symptomatic duodenal obstruction has increased [1]. Biliary and/or gastrointestinal bypass, either surgically or endoscopically, is considered to be a choice of treatment for such patients with unresectable pancreatic cancer. Bypass surgery for pancreatic cancer is usually done to palliate the obstructive symptoms in the biliary and/or digestive system.
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