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
- 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.
- The jejunal sidewall is opened, effectuating a small hole with a diameter that matches the diameter of the main pancreatic duct.
- The other side of the stent tube is introduced into the jejunal lumen via the new-formed opening.
- 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.
- 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.
