Pancreatic Anastomosis Techniques2017-08-21T13:13:53+02:00


Pancreatoduodenectomy offers the best chances for long-term survival to patients with pancreatic and periampullary malignancy. However, this is a technically challenging procedure, with a pancreatoenteric anastomosis as the standard procedure for managing the pancreatic remnant.

Failure of the pancreatic anastomosis, resulting in potentially life-threatening pancreatic fistula, is a dreaded complication after pancreatoduodenectomy. To reduce the incidence of pancreatic fistula, many different types of pancreatic anastomoses have been proposed.

About this website

This website provides a complete overview of all pancreatic anastomosis techniques ever published. Based on three fundamental groups, i.e. end-to-end pancreatojejunostomy, end-to-side pancreatojejunostomy and end-to-side pancreatogastrostomy, a total of 66 techniques are summarized and visualized.

This website can be used as an interactive platform for pancreatic surgeons to share their personal anastomosis technique, for uniformity in reporting anastomosis techniques in future research and as a learning tool to give insight into the various possibilities of restoring pancreatoenteric continuity.


  • Lois A. Daamen,
  • F. Jasmijn Smits,
  • Marc G. Besselink,
  • Olivier R. Busch,
  • Inne H. Borel Rinkes,
  • Hjalmar C. van Santvoort,
  • I. Quintus Molenaar

For the Dutch Pancreatic Cancer Group

>> Send your anastomosis technique, photo’s and videoclips for publication on this website to us<<


Duct-to-mucosa technique

An incision is made in the seromuscular layer of the jejunal wall, comparable with the size of the pancreatic stump. Sutures are placed between the posterior edge of the seromuscular jejunal incision and the posterior pancreatic capsule to form the posterior part of the outer suture-row. (meer…)

Blumgart anastomosis

An opening is made in the seromuscular side wall of the jejunum, with a size similar to the diameter of the pancreas. The Blumgart anastomosis is constructed by four to six transpancreatic U-sutures: two to three on each side of the main pancreatic duct. Suture-threads with a needle on both ends are used. (meer…)

One-layered technique

A gastrotomy with a size similar to the diameter of the pancreas is made in the posterior wall of the stomach. The pancreatic remnant is invaginated into the gastric lumen for 1-3 cm. (meer…)


The edge of the stump is tightly wrapped around using an absorbable or non-absorbable mesh with a width of 1.0-1.5 cm and a length that matches the circumferential length of the pancreas. The mesh is placed about 1.0 cm from the cut margin of the pancreas and can be fixed onto the pancreatic capsule with a few stitches. (meer…)