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Updated: Jun 7, 2026
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Biliary diversion Q-shape reconstruction after pancreaticoduodenectomy: Chang's reconstruction
1Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan. changyc@mail.ncku.edu.tw
Background/Aims:
This is a simple and easy reconstruction method designed for safely performing a pancreaticoduodenectomy (PD), even when it is complicated by a leakage from pancreaticojejunostomy (PJ).
Methodology:
Five patients with periampullary malignancy underwent PD with biliary diversion Q-shaped reconstruction. An end-to-side anastomosed proximal jejunal loop (30 cm), divided by a gastrointestinal anastomosis (GIA) stapler at its top and reapproximated by intermittent serosal sutures, was used for a choledochojejunostomy and a PJ (fistulation, duct-to-mucosa, or end-to-side method) at each divided loop. Then gastrojejunostomy or duodenojejunostomy was made 30 cm distal to the jejunojejunostomy of the loop.
Results:
The clinic courses were surprisingly uneventful. There was no mortality. One patient showed a minor pancreatic leakage, one pylorus-preserving patient experienced a 25-day delay in gastric emptying, and another patient required second operation for intra-abdominal bleeding from a tiny branch of the superior mesenteric artery.
Conclusion:
Biliary diversion Q-shaped PD is a safer reconstruction method for reducing lethal hemorrhagic crisis associated with PJ anastomotic leakage after PD.
