<p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> <p>We propose a method of reconstruction after pancreaticoduodenectomy consisting of a double Roux en Y
on the same jejunal loop without interruption of the mesentery and a third anatomical Roux en Y to
reconstitute the alimentary tract.</p> <p>The construction of the double Roux en Y draining pancreas and bile ducts separately, requires a linear
Stapler 3-4 centimeters from the biliary anastomosis. In this way, by employing the same loop without
mesenteric interruption, two functional excluded loops will be ’obtained. The rationale of the suggested
model is based on the separation of biliary and pancreatic secretions. This makes it possible to avoid a
stagnant cul-de-sac coinciding with the pancreaticojejunal anastomosis and to obtain in the case of
leakage, a pure biliary and/or pancreatic fistula as far as is possible.</p> <p>99mTc HIDA scans demonstrated the efficiency, of the biliopancreatic limbs of the reconstruction,
showing normal emptying time for the gastric remnant and the absence of radionuclide stagnation or any
alkaline enterogastric reflux.</p>
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HPB Surg. 1996; 9(4):223-227