A full-thickness incision is made in the jejunal side wall with a size similar to the diameter of the pancreas. A purse-string suture is applied in the seromuscular layer around the new-formed opening in the jejunum. Four to five stay sutures are placed in the pancreatic capsule around the pancreatic remnant.

One-layered invagination end-to-side pancreatojejunostomy without stitches in the pancreatic stump

  1. A full-thickness incision is made in the jejunal side wall with a size similar to the diameter of the pancreas.
  2. A purse-string suture is applied in the seromuscular layer around the new-formed opening in the jejunum.
  3. Four to five stay sutures are placed in the pancreatic capsule around the pancreatic remnant.
  4. The pancreas is invaginated into the jejunum via the jejunal side incision using the preplaced stay sutures.
  5. The stay sutures are fixed onto the jejunal seromuscular wall around the incision; herewith the depth of invagination of the pancreatic stump is secured.
  6. The purse-string suture is tied gently; care is taken to avoid occlusion of the main pancreatic duct.
  7. With this invagination technique, the pancreatic stump is inserted into the jejunum without placing any sutures on the pancreatic cut surface.

  • Hashimoto D, Hirota M, Chikamoto A, Beppu T, Baba H. Short-term outcome of new end-to-side inserting pancreatico-jejunostomy without stiches on the pancreatic cut end. Hepatogastroenterology. 2014;61:489-492.
  • Hashimoto D, Hirota M, Yagi Y, Baba H. End-to-side pancreaticojejunostomy without stitches in the pancreatic stump. Surg Today. 2013;43:821-824.