Technical Considerations of the Jejunal Limb Route During Pancreaticoduodenectomy Following Total Colectomy for Familial Adenomatous Polyposis: A Case Report and Literature Review.

BACKGROUND/AIM: Patients with familial adenomatous polyposis (FAP) can develop multiple adenomatous polyps in the gastrointestinal tract, including the duodenum and large intestine. Few studies have reported surgical techniques for pancreaticoduodenectomy (PD) after prophylactic colorectal surgery, although this is technically challenging. CASE REPORT: We describe the surgical technique used in a 46-year-old man with FAP who underwent PD for a papillary adenoma after prophylactic total colectomy. After resection of the specimen, the jejunal limb was elevated via the Treitz route (retro-remnant mesocolic plane) for pancreaticojejunostomy and hepaticojejunostomy. Subsequently, gastrojejunostomy was performed via an isoperistaltic route. To the best of our knowledge, this is the first study to present the technical aspects of PD after total colectomy, focusing on the jejunal limb route during reconstruction. CONCLUSION: The present study highlights the clinical course of a patient who underwent PD after prophylactic total colectomy for FAP. As a functional mesocolic plane is absent in patients who have undergone prophylactic total colectomy, special considerations of the jejunal limb route are required in PD after prophylactic colorectal surgery. This approach may be an optional and feasible strategy for successful PD after prophylactic colorectal surgery.