Background : Chronic pancreatitis (CP) is pathologic fibroinflammatory condition in individuals with genetic, environmental who develop persistent morphological changes. Common Bile Duct Obstruction (CBDO) occurs as consequence of recurrent acute inflammatory episodes which may ultimately result in periductal fibrotic stricture. Today endoscopic treatment considers as first-line management for CBDO and CP. Surgery considers as definitive treatment if unsuccessful endoscopic treatment with major aims are long-lasting pain relief and preservation of endocrine and exocrine function. This manuscript descibes technique for Combined Laparoscopic Lateral Pancreaticojejunostomy (LPJ) And Choledochojejunostomy (CDJ) in patients with CP and CBDO. A short video with case presentation and highlights of important steps of surgery is included.

Methods : A 62-year-old Male suffered from intractable abdominal pain attributed to CP and imaging demonstrated CBDO underwent Combined laparoscopic LPJ and CDJ to mitigate symptom after failure of Endoscopic retrograde cholangiopancreatography and Extracorporeal Shock Wave Lithotripsy. The most challenging part of procedure was identification of main pancreatic duct by using laparoscopic ultrasound and lumbar puncture needle aspiration. We demonstrated Double gastroduodenal hanging technique, Intraoperative Pancreatoscopy and Cholodochoscopy were performed to confirm duct clearance, LPJ and CDJ anastomosis technique.

Results : The whole surgical procedure lasted 6 hours with intraoperative blood loss 30 ml. There have been no major complications, pain relief has been completed on post-operative day (POD) 2. The patient was tolerating full soft diet and removed surgical drains on POD 5 and discharged on POD 7.

Conclusions : Combined laparoscopic LPJ and CDJ is effective salvage treatment for chronic pancreatitis with CBD obstruction who failed endoscopic treatment.