Bilio-digestive double bypass for nonresectable pancreatic cancer

In spite of extensive preoperative investigation, surgical exploration is often the only way to determine whether a pancreatic cancer is curatively resectable. If curative resection is not possible, palliation of cholestasis and eventual duodenal obstruction is mandatory. This is best achieved by construction of a bilio-digestive double bypass. Many different techniques have been described but considerable rates of delayed gastric emptying have added high morbidity to the procedure. We propose a retrocolic construction technique combining an omega loop with a Roux-en-Y reconstruction which to our knowledge has not been published before.