Journal of Gastrointestinal Surgery

, Volume 20, Issue 4, pp 861–866 | Cite as

Laparoscopic Longitudinal Pancreaticojejunostomy Using Barbed Sutures: an Efficient and Secure Solution for Pancreatic Duct Obstructions in Patients with Chronic Pancreatitis

  • Eun Young Kim
  • Tae Ho Hong
How I do it


We describe our laparoscopic longitudinal pancreaticojejunostomy (LPJ) technique using barbed sutures to manage a pancreatic duct obstruction. We performed laparoscopic longitudinal anterior pancreaticojejunostomy using barbed sutures (3-0 absorbable wound closure device, V-Loc™, Covidien, Minneapolis, MN, USA) in 11 patients who presented with signs of a pancreas ductal obstruction and chronic pancreatitis. The surgical outcomes and follow-up records at the outpatient department were reviewed, and the effectiveness and feasibility of this method were analyzed. Mean patient age was 54.4 ± 9.5 years, and pancreatic duct stones were removed from all patients without conversion to laparotomy. Overall operative time was 200.7 ± 56.4 min, and estimated blood loss was 42.2 ± 11.2 ml. No pancreatic anastomosis leakage or postoperative bleeding was detected. Mean length of hospital stay was 6.5 ± 0.8 days, and mean time to start a soft diet was 4.8 ± 0.7 days. No patient complained of postoperative abdominal pain, and all patients recovered without significant complications or relapse of pancreatitis. The follow-up period was 4–21 months. Our new laparoscopic longitudinal anterior pancreaticojejunostomy technique (Puestow procedure) using barbed sutures is a potentially efficient and minimally invasive procedure for patients who suffer from pancreatic duct obstruction and chronic pancreatitis.


Chronic pancreatitis Laparoscopy Longitudinal pancreaticojejunostomy 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.


  1. 1.
    Puestow CB, Gillesby WJ. Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 1958;76:898–907.CrossRefPubMedGoogle Scholar
  2. 2.
    Adams DB. The Puestow procedure: how I do it. J Gastrointest Surg 2013;17:1138–1142.CrossRefPubMedGoogle Scholar
  3. 3.
    Sahoo MR, Kumar A. Laparoscopic longitudinal pancreaticojejunostomy using cystoscope and endoscopic basket for clearance of head and tail stones. Surg Endosc 2014;28:2499–2503.CrossRefPubMedGoogle Scholar
  4. 4.
    Zhang JS, Li L, Liu SL, Hou WY, Diao M, Zhang J, Li SL, Ming AX, Liu Y, Wang HB, Cheng W. Laparoscopic pancreaticojejunostomy for pancreatic ductal dilatation in children. J Pediatr Surg 2012;47:2349–2352.CrossRefPubMedGoogle Scholar
  5. 5.
    Tanaka M, Matsumoto I, Shinzeki M, Asari S, Goto T, Yamashita H, Ishida J, Ajiki T, Fukumoto T, Ku Y. Short- and long-term results of modified Frey's procedure in patients with chronic pancreatitis: a retrospective Japanese single-center study. Kobe J Med Sci 2014;60:E30-36.PubMedGoogle Scholar
  6. 6.
    Dite P, Ruzicka M, Zboril V, Novotný I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 2003;35:553–558.CrossRefPubMedGoogle Scholar
  7. 7.
    Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, Stoker J, Laméris JS, Dijkgraaf MG, Huibregtse K, Bruno MJ. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007;356:676–684.CrossRefPubMedGoogle Scholar
  8. 8.
    Rieder S, Michalski CW, Friess H. Indications for endoscopic or surgical treatment of chronic pancreatitis. Dig Dis 2010;28:344–349.CrossRefPubMedGoogle Scholar
  9. 9.
    Jeppe CY, Becker P, Smith MD. Post-Frey procedure quality of life in South African patients with painful chronic pancreatitis. JOP 2013;14:21–30.PubMedGoogle Scholar
  10. 10.
    Laje P, Adzick NS. Modified Puestow procedure for the management of chronic pancreatitis in children. J Pediatr Surg 2013;48:2271–2275.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  1. 1.Department of Hepato-biliary and Pancreas Surgery, College of Medicine, Seoul St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea

Personalised recommendations