Inverted mattress suturing technique

The jejunal sidewall is opened for a size similar to the diameter of the pancreatic stump. A total of five to six U-sutures are applied following an inverted mattress suturing technique. The first three to four sutures go through the full-thickness of the posterior jejunal wall, from outside to inside, and through the seromuscular wall of the jejunum back to outside, inverting the seromuscular coat of the jejunum.

One-layered invagination pancreatojejunostomy using inverted mattress sutures

  1. The jejunal sidewall is opened for a size similar to the diameter of the pancreatic stump.
  2. A total of five to six U-sutures are applied following an inverted mattress suturing technique. The first three to four sutures go through the full-thickness of the posterior jejunal wall, from outside to inside, and through the seromuscular wall of the jejunum back to outside, inverting the seromuscular coat of the jejunum.
  3. The sutures are placed straight through the pancreatic stump, from posterior to anterior, penetrating the full-thickness of the pancreas.
  4. For inversion of the anterior seromuscular jejunal wall, the sutures are placed from outside to inside through the seromuscular layer of the jejunum and back to outside through the full-thickness of the anterior jejunal wall.
  5. On both the superior and inferior corners of the anastomosis, an extra U-suture is placed in a similar manner, fixing respectively the superior and inferior ends of the pancreas.
  6. All sutures are tied gently, causing invagination of the pancreatic remnant into the jejunum.

  • Kwon HJ, Ha HT, Choi YY, Kim SG. The effects of the end-to-side inverted mattress pancreaticojejunostomy on postoperative pancreatic fistula: a single surgeon’s experience. Ann Surg Treat Res. 2015;89:61-67.