Laparoscopic Roux-en Y duodenojejunostomy: A safe and physiological treatment for symptomatic annular pancreas in adults

Abstract

Background: Annular pancreas is a rare, congenital, rotational anomaly of pancreas, seen usually in newborns who present with features of duodenal obstruction. However, in adults, only 24% of cases are present with duodenal obstruction. Surgery remains the procedure of choice in patients in whom symptoms can be attributed to duodenal obstruction and the goal of surgery is to relieve obstruction by bypassing the annulus. Laparoscopic Roux-en Y duodenostomy (DJ) is our preferred bypass approach for this condition. Literature search revealed that very few case reports have been published about laparoscopic management of annular pancreas, especially about duodenojejunal anastomosis. We present our experience in the laparoscopic management of symptomatic annular pancreas in adults and technique of the laparoscopic Roux-en Y DJ for annular pancreas.

Materials and methods: Between 1996 and 2016, a total of six adult patients underwent laparoscopic management for symptomatic annular pancreas. The demographic, perioperative and follow-up details were documented.

Results: All surgeries were successfully performed by laparoscopic approach with no conversion to open. Five cases underwent Roux-en Y DJ and one underwent gastrojejunostomy. No major perioperative events occurred. The mean length of hospital stay was 5.6 days. Five out of six patients were followed up for 24 months, and no symptom recurrence was seen.

Conclusion: Laparoscopic Roux-en Y duodenojejunostomy could be used as a safe and physiological treatment for annular pancreas in adult patients and should be preferred for the treatment of duodenal obstruction due to annular pancreas.

Keywords: Annular pancreas; Roux-en Y duodenojejunostomy; congenital pancreatic anomaly; duodenal obstruction; laparoscopy.

Figure 1

Technique for laparoscopic Roux-en Y DJ bypass. (a) Team set-up and port placement. (b) Annulus of pancreas. (c) Side-to-side duodenojejunal stapled anastomosis. (d) Completion of DJ anastomosis

Figure 2

Diagnostic modalities showing annular pancreas. (a) Upper GI barium study showing dilated stomach and proximal with narrowing of the 2^nd part of duodenum. (b) Magnetic resonance imaging abdomen showing annular pancreas (thin arrow) (c) contrast-enhanced computed tomography abdomen showing annular pancreas (white arrow). (d) Laparoscopic view of annular pancreas (white arrow)