Skip to main content
Log in

Laparoscopic lateral pancreaticojejunostomy: an evolution to endostapled technique

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript



Chronic pancreatitis (CP) is a debilitating condition resulting in severe pain with progressive deterioration of pancreatic function. “Tropical” pancreatitis represents a variant of the disease with widely dilated ducts, numerous calculi, and few strictures. Traditionally, modified Puestow’s procedure has been the treatment of choice for a dilated pancreatic ductal system. However, it has only recently been adapted to laparoscopic approach which is a technically demanding procedure primarily due to need for extensive intra-corporeal suturing.


Symptomatic cases of CP presenting at our center with minimum 8 mm mean ductal diameter at body and head were selected for laparoscopic modified Puestow’s procedure. Those with prior pancreatic surgery, pancreatic head masses, endoscopic pancreatic stenting, and portal hypertension were excluded. Twenty-eight cases meeting selection criteria underwent a laparoscopic procedure.


Seven patients (25%) underwent a stapled pancreaticojejunal anastomosis, 17 (60.7%) received a sutured anastomosis. Four patients (14.3%) were converted to open surgery due to failure to localize the pancreatic duct with percutaneous needle aspiration. Of those patients who underwent a successful laparoscopic procedure, a single patient developed a pancreatic fistula which resolved spontaneously; another patient had a difficult post-operative course with prolonged intensive care. We suffered no mortality within the series and no patient had any long-term disability. Anastomotic patency rates of 100% were achieved by the third post-operative month.


Lateral pancreaticojejunostomy is an effective surgical management for CP with a dilated ductal system. Its laparoscopic adoption is the rational next surgical step. It allows effective duct decompression with low mortality and morbidity. The procedure demands an advanced surgical skill set with an emphasis on intra-corporeal suturing. Those patients suffering from tropical CP with wide ductal dilatation greater than 12 mm are suited to an endostapled anastomosis which helps significantly reduce operative time without any corrosion of outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others


  1. Barman KK, Premalatha G, Mohan V (2003) Tropical chronic pancreatitis. Postgrad Med J 79(937):606–615.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Das SK, Balakrishnan V, Vasudevan DM (2006) Alcohol: its health and social impact in India. Natl Med J India 19(2):94–99. Accessed 8 Feb 2018

  3. Pezzilli R, Morselli Labate AM, Ceciliato R et al (2005) Quality of life in patients with chronic pancreatitis. Dig Liver Dis 37(3):181–189.

    Article  CAS  PubMed  Google Scholar 

  4. Balakrishnan V, Nair P, Radhakrishnan L, Narayanan VA (2006) Tropical pancreatitis—a distinct entity, or merely a type of chronic pancreatitis? Indian J Gastroenterol 25(2):74–81. Accessed 22 Sep 2016

  5. Wick EC, Hoge SG, Grahn SW et al (2006) Transient receptor potential vanilloid 1, calcitonin gene-related peptide, and substance P mediate nociception in acute pancreatitis. Am J Physiol Gastrointest Liver Physiol 290(5):G959–G969.

    Article  CAS  PubMed  Google Scholar 

  6. Garg PK, Tandon RK (2004) Survey on chronic pancreatitis in the Asia-Pacific region. J Gastroenterol Hepatol 19(9):998–1004.

    Article  PubMed  Google Scholar 

  7. Paliwal S, Bhaskar S, Chandak GR (2014) Genetic and phenotypic heterogeneity in tropical calcific pancreatitis. World J Gastroenterol 20(46):17314–17323.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Glaser C, Müller W, Zerz A, Szinicz G (2000) Laparoscopic latero-lateral pancreaticojejunostomy. Der Chir Zeitschrift für alle Gebiete der Oper Medizen 71(4):456–457. Accessed 20 Sep 2016

  9. Kuroki T, Adachi T, Okamoto T, Kanematsu T (2011) Single-incision laparoscopic distal pancreatectomy. Hepatogastroenterology 58(107–108):1022–1024. Accessed 22 Feb 2018

  10. Partington PF, Rochelle RE (1960) Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 152(6):1037–1043. Accessed 8 Feb 2018

  11. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hartmann D, Friess H (2015) Surgical approaches to chronic pancreatitis. Gastroenterol Res Pract 2015:503109.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kurian MS, Gagner M (1999) Laparoscopic side-to-side pancreaticojejunostomy (Partington-Rochelle) for chronic pancreatitis. J Hepatobiliary Pancreat Surg 6(4):382–386. Accessed 10 Feb 2018

  14. Khaled YS, Ammori MB, Ammori BJ (2011) Laparoscopic lateral pancreaticojejunostomy for chronic pancreatitis: a case report and review of the literature. Surg Laparosc Endosc Percutan Tech 21(1):e36–e40.

    Article  PubMed  Google Scholar 

  15. Kuroki T, Eguchi S (2015) Laparoscopic longitudinal pancreaticojejunostomy for chronic pancreatitis. JOP 16(5):438-443. Accessed 10 Feb 2018

  16. Palanivelu C, Shetty R, Jani K et al (2006) Laparoscopic lateral pancreaticojejunostomy: a new remedy for an old ailment. Surg Endosc Other Interv Tech 20(3):458–461.

    Article  CAS  Google Scholar 

  17. Biteman BR, Harr JN, Brody F (2016) Laparoscopic Puestow: lateral pancreaticojejunostomy. Surg Endosc 30(12):5624–5624.

    Article  PubMed  Google Scholar 

  18. Tantia O, Jindal MK, Khanna S, Sen B (2004) Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases. Surg Endosc 18(7):1054–1057.

    Article  CAS  PubMed  Google Scholar 

  19. Palanivelu C, Ahluwalia JS, Parthasarathi R et al (2011) Laparoendoscopic single-site lateral pancreaticojejunostomy. Pancreatology 11(5):500–505.

    Article  CAS  PubMed  Google Scholar 

  20. Sahoo MR, Kumar A (2014) Laparoscopic longitudinal pancreaticojejunostomy using cystoscope and endoscopic basket for clearance of head and tail stones. Surg Endosc 28(8):2499–2503.

    Article  PubMed  Google Scholar 

  21. Meehan JJ, Sawin R (2011) Robotic lateral pancreaticojejunostomy (Puestow). J Pediatr Surg 46(6):e5–e8.

    Article  PubMed  Google Scholar 

  22. Eid GM, Entabi F, Watson AR, Zuckerbraun BS, Wilson MA (2011) Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy. J Gastrointest Surg 15(7):1243–1243.

    Article  PubMed  Google Scholar 

  23. Edil BH, Cooper MA, Makary MA (2014) Laparoscopic pancreaticojejunostomy using a barbed suture: a novel technique. J Laparoendosc Adv Surg Tech 24(12):887–891.

    Article  Google Scholar 

  24. Kim EY, Hong TH (2016) Laparoscopic longitudinal pancreaticojejunostomy using barbed sutures: an efficient and secure solution for pancreatic duct obstructions in patients with chronic pancreatitis. J Gastrointest Surg 20(4):861–866.

    Article  PubMed  Google Scholar 

  25. Tan C-L, Zhang H, Li K-Z (2015) Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis. World J Gastroenterol 21(44):12644–12652.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Izbicki JR, Bloechle C, Broering DC, Knoefel WT, Kuechler T, Broelsch CE (1998) Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy. Ann Surg 228(6):771–779. Accessed 22 Feb 2018

  27. Justin V, Fingerhut A, Khatkov I, Uranues S (2016) Laparoscopic pancreatic resection-a review. Transl Gastroenterol Hepatol 1:36.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ali UA, Nieuwenhuijs VB, van Eijck CH et al (2012) Clinical outcome in relation to timing of surgery in chronic pancreatitis. Arch Surg 147(10):925–932.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Eham Arora.

Ethics declarations


Dr. Ajay Bhandarwar, Dr. Eham Arora, Dr. Raj Gajbhiye, Dr. Saurabh Gandhi, Dr. Chintan Patel, Dr. Amol Wagh, Dr. Priyank Kothari, and Dr. Shekhar Jadhav have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhandarwar, A., Arora, E., Gajbhiye, R. et al. Laparoscopic lateral pancreaticojejunostomy: an evolution to endostapled technique. Surg Endosc 33, 1749–1756 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: