ROBOTIC REDO PANCREATICOJEJUNOSTOMY FOR STENOSIS FOLLOWING PANCREATICODUODENECTOMY: AN ALTERNATIVE TECHNIQUE

摘要

Pancreaticoduodenectomy is the procedure of choice for several diseases from benign or pre-malignant lesions to malignancy (1) . One of the most frequent late complications is the stenosis of the pancreato-enteric anastomosis (2-4) . This complication is observed in 25%-60% of radiological images during follow-up (2) . Although frequent, this stenosis is often asymptomatic but in certain circumstances this stenosis may lead to recurrent acute pancreatitis, pain and pancreatic exocrine insufficiency. About 2% of all patients will develop a symptomatic pancreaticojejunostomy stricture needing treatment (3,4) . We present an alternative technique for the surgical revision of pancreaticojejunostomy using robotic approach. A 60-year-old woman underwent laparoscopic Whipple procedure two years ago. After 6 months, she presented with acute pancreatitis. MRI showed mild dilation of the main pancreatic duct and the patient was conservatively treated. However, since then, she presented several episodes of acute pancreatitis. MRI showed a complete stenosis of the pancreaticojejunostomy with pronounced dilation of the main pancreatic duct (FIGURE Multidisciplinary team decided for revision surgery (E-VIDEO*).