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PubMed This is a summary of 14 peer-reviewed journal articles Updated
Surgery

The Surgical Detour: Bypassing the Blockage

At a Glance

The safest and most effective treatment for an annular pancreas blockage is a surgical bypass, rather than cutting the pancreatic ring. A bypass, such as a duodenoduodenostomy, restores normal digestion while avoiding dangerous leaks of digestive enzymes.

When annular pancreas causes a blockage, the goal of treatment is to restore a clear path for food and liquid to travel through the digestive system [1][2]. While it might seem logical to simply “cut the ring,” the standard of care for decades has been to leave the pancreas alone and create a bypass [3].

Why We Bypass Instead of Cut

The pancreatic ring is not just “extra” tissue; it is functional organ tissue that contains delicate drainage ducts [4].

  • The Risk of Pancreatic Fistula: If a surgeon cuts through the ring, they risk damaging these hidden ducts. This can lead to a pancreatic fistula—an abnormal leak where powerful digestive enzymes escape from the pancreas and “digest” surrounding tissues [5][6]. These leaks are difficult to treat and can lead to severe complications [5].
  • The Problem of Scarring: Even if the ring is cut, the underlying duodenum (intestine) is often permanently narrowed or scarred from years of being squeezed. Cutting the ring may not actually fix the internal blockage [7].

By performing a bypass, surgeons create a “detour” around the squeezed area, which effectively resolves the blockage while keeping the pancreas intact and safe [1][8].

Common Surgical Techniques

Depending on the patient’s age and anatomy, surgeons use a few specific methods to create this detour:

  1. Duodenoduodenostomy (The “Diamond-Shaped” Repair): This is the gold standard for newborns [9]. The surgeon makes two small incisions—one horizontal and one vertical—on either side of the blockage and sews them together. When finished, the opening looks like a diamond. This shape is specifically designed to stay wide open and prevent future narrowing as the child grows [10][11].
  2. Duodenojejunostomy: Often used in adults, this involves connecting the duodenum directly to the next part of the small intestine (the jejunum), bypassing the pancreatic ring entirely [1][12].

Modern Approaches: Laparoscopic and Robotic

Many centers now offer “minimally invasive” options, meaning the surgery is done through a few tiny incisions rather than one large one.

  • Laparoscopic Surgery: Uses a camera and long, thin instruments. It is associated with less pain and faster recovery [9][1].
  • Robotic-Assisted Surgery: This allows for extreme precision, especially in the tiny spaces of a newborn’s abdomen. Robotic systems can provide 3D visualization and “wristed” instruments that make sewing the bypass easier and more accurate [13][14].

What to Expect During Recovery

The “detour” created by surgery allows the digestive system to function normally again, but healing takes time.

  • Neonatal Recovery: For newborns, the bowel can take time to “wake up” after surgery. This often requires a NICU stay of 2-4 weeks. During this time, the baby will not eat by mouth. Nutrition is provided directly into the bloodstream through an IV (Total Parenteral Nutrition, or TPN) until the intestine heals and normal feeding can safely begin [9].
  • Adult Recovery: Adults often have a slightly shorter transition but will still rely on IV fluids or a temporary feeding tube before liquids and soft foods are gradually reintroduced [13].
  • Long-Term Success: Once the bypass is healed, the vast majority of patients live normal lives with the physical blockage permanently resolved [9][3].

Common questions in this guide

Why do surgeons bypass an annular pancreas instead of just cutting the ring?
Surgeons avoid cutting the ring because the tissue contains delicate drainage ducts. Cutting it risks a pancreatic fistula, which is a dangerous leak of powerful digestive enzymes that can damage surrounding tissues.
What is a duodenoduodenostomy?
A duodenoduodenostomy is the gold standard bypass surgery for newborns. The surgeon connects the intestine above and below the blockage using a diamond-shaped repair, which stays wide open to prevent future narrowing as the child grows.
How long is the recovery for a newborn after annular pancreas surgery?
Newborns typically require a NICU stay of two to four weeks because the bowel takes time to wake up after surgery. During this recovery period, the baby receives nutrition directly through an IV until normal feeding can safely begin.
Can annular pancreas surgery be done with minimally invasive techniques?
Yes, many centers now offer laparoscopic or robotic-assisted bypass procedures. These minimally invasive techniques use small incisions, which generally cause less pain and allow for a faster recovery than traditional open surgery.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Why do you recommend a bypass procedure like a duodenoduodenostomy instead of simply cutting the ring of tissue?
  2. 2.Will the surgery be performed laparoscopically or robotically, and what are the specific benefits for me/my child?
  3. 3.Can you explain the 'diamond-shaped' technique and how it prevents future narrowing (strictures) of the intestine?
  4. 4.What is the plan if a pancreatic fistula occurs, even though we are bypassing the tissue?
  5. 5.How long do you realistically expect the hospital stay to be before we can resume normal feedings?

Questions For You

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References

References (14)
  1. 1

    Laparoscopic Roux-en Y duodenojejunostomy: A safe and physiological treatment for symptomatic annular pancreas in adults.

    Chittawadagi B, Senthilnathan P, Jankar SV, et al.

    Journal of minimal access surgery 2020; (16(2)):121-125 doi:10.4103/jmas.JMAS_245_18.

    PMID: 30618433
  2. 2

    Annular Pancreas Presenting with Intermittent Duodenal Obstruction in Early Childhood: A Diagnostic Masquerade.

    Rogalidou M, Papagiannis G, Galina P, et al.

    Reports (MDPI) 2026; (9(1)) doi:10.3390/reports9010026.

    PMID: 41562824
  3. 3

    Annular pancreas causing duodenal obstruction in a 23 year old women managed surgically for gastrojejunostomy; a case report.

    Nur NM, Artan A, Omar AA, Ahmed MR

    International journal of surgery case reports 2022; (101()):107804 doi:10.1016/j.ijscr.2022.107804.

    PMID: 36455345
  4. 4

    Exome sequencing findings in children with annular pancreas.

    Pitsava G, Pankratz N, Lane J, et al.

    Molecular genetics & genomic medicine 2023; (11(10)):e2233 doi:10.1002/mgg3.2233.

    PMID: 37635636
  5. 5

    Portal Annular Pancreas (PAP): an Underestimated Devil in Pancreatic Surgery-Systematic Review of Literature and Case Report.

    Pandrowala S, Parray A, Chaudhari V, et al.

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2021; (25(5)):1332-1339 doi:10.1007/s11605-021-04927-0.

    PMID: 33555524
  6. 6

    Challenges and outcomes of pancreato-duodenectomy in portal annular pancreas: A single center experience with a systematic review of the literature.

    Modak S, Tilloo R, Ahmed Z, et al.

    Annals of hepato-biliary-pancreatic surgery 2025; (29(3)):308-316 doi:10.14701/ahbps.25-027.

    PMID: 40404589
  7. 7

    From duodenitis to stricture: Decoding the impact of partial annular pancreas over years.

    Alok H, Bansal L, Prasad A

    Abdominal radiology (New York) 2026; (51(4)):1765-1769 doi:10.1007/s00261-025-05194-2.

    PMID: 41369896
  8. 8

    Laparoscopic Roux-en-Y duodenojejunostomy for annular pancreas in adults: case report and literature review.

    Cai H, Wang X, Cai YQ, et al.

    Annals of translational medicine 2018; (6(11)):211 doi:10.21037/atm.2018.05.13.

    PMID: 30023374
  9. 9

    Diamond-shaped versus side-to-side anastomotic duodenoduodenostomy in laparoscopic management of annular pancreas in children: a single-center retrospective comparative study.

    Liang Z, Lan M, Xu X, et al.

    Translational pediatrics 2023; (12(10)):1791-1799 doi:10.21037/tp-23-156.

    PMID: 37969116
  10. 10

    Laparoscopic duodenoduodenostomy with parallel anastomosis for duodenal atresia.

    Oh C, Lee S, Lee SK, Seo JM

    Surgical endoscopy 2017; (31(6)):2406-2410 doi:10.1007/s00464-016-5241-y.

    PMID: 27655378
  11. 11

    Annular pancreas as a cause of neonatal duodenal obstruction, a case report.

    Gutiérrez-González JA, González De La Torre E, Armijo-Borjón EA, et al.

    Journal of surgical case reports 2023; (2023(7)):rjad407 doi:10.1093/jscr/rjad407.

    PMID: 37489161
  12. 12

    Annular pancreas causing pyloric stenosis in a 66-year-old patient treated with gastrojejunostomy: a case report.

    Patel P, Diko S, Kulkarni S, et al.

    Journal of surgical case reports 2021; (2021(4)):rjab125 doi:10.1093/jscr/rjab125.

    PMID: 33927863
  13. 13

    Robotic versus laparoscopic approaches to neonatal annular pancreas: a comparative analysis of surgical outcomes and innovation trade-offs.

    Gan Y, Zheng Z, Wang H, et al.

    Surgical endoscopy 2025; (39(12)):8033-8042 doi:10.1007/s00464-025-12197-z.

    PMID: 40935936
  14. 14

    Robotic pancreaticoduodenectomy for portal annular pancreas: how to do it.

    Ishida J, Toyama H, Nanno Y, et al.

    Surgery today 2025; (55(7)):1004-1007 doi:10.1007/s00595-024-02976-x.

    PMID: 39714719

This page explains surgical treatments for annular pancreas for educational purposes only. Always consult your surgeon or pediatric specialist for medical advice regarding your or your child's specific treatment and recovery plan.

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