A 63-year old male was referred with intraductal papillary adenocarcinoma of the pancreas. The patient had been treated previously with a distal gastrectomy for duodenal ulceration. This surgery left the patient with esophagitis, residual gastritis, and decreased appetite. A modification of the Imanaga reconstructive method using a double-jejunal pouch was performed for the pancreatic carcinoma. This method allows a better quality of life by not only preventing reflux esophagitis and residual gastritis but also increasing a food volume. Here we illustrate the usefulness of a pancreaticoduodenectomy using the pouching operation.
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