Purse-string suturing technique

A purse-string suture is applied through the main pancreatic duct and the peri-ductal pancreatic parenchyma, after which the suture is brought to outside via the ductal lumen. A stent tube is inserted into the main pancreatic duct and anchored by tying the purse-string suture. Care is taken to avoid occlusion of the pancreatic duct.

One-layered invagination end-to-side pancreatojejunostomy using a purse-string suture

  1. A purse-string suture is applied through the main pancreatic duct and the peri-ductal pancreatic parenchyma, after which the suture is brought to outside via the ductal lumen.
  2. A stent tube is inserted into the main pancreatic duct and anchored by tying the purse-string suture. Care is taken to avoid occlusion of the pancreatic duct.
  3. The jejunal sidewall is opened, effectuating a small hole with a diameter that matches the diameter of the main pancreatic duct.
  4. The other side of the stent tube is introduced into the jejunal lumen via the new-formed opening.
  5. For insertion of the pancreatic cut surface into the seromuscular wall of the jejunum, a second purse-string suture is performed. This is done, by taking 10-15 small bites of seromuscular jejunal layer and proximal pancreatic capsule circumferentially. After tying the purse-string gently, the pancreatic stump is enveloped completely by the bowel wall.
  6. The anastomosis is completed by applying five to ten sutures between the seromuscular layer of the jejunum and the pancreatic capsule.

  • Jiang C, Wang M, Xu Q, Wu X, Yu D, Ding Y. A modified technique for end-to-side pancreaticojejunostomy by purse-string suture. J Surg Oncol. 2011;104:852-856.