Vertical mattress suturing technique

An incision is made in the sidewall of the jejunal loop, with a size matching the diameter of the pancreatic cut surface. The one-layered invagination end-to-side pancreatojejunostomy is performed using a mattress suturing technique. To this purpose, transpancreatic U-sutures are placed. The suturing is started at the posterior wall of the jejunum, penetrating the full-thickness of the jejunal wall from outside to inside, exciting the jejunal lumen again from the new-made opening.

One-layered invagination pancreatojejunostomy using vertical mattress sutures

  1. An incision is made in the sidewall of the jejunal loop, with a size matching the diameter of the pancreatic cut surface.
  2. The one-layered invagination end-to-side pancreatojejunostomy is performed using a mattress suturing technique. To this purpose, transpancreatic U-sutures are placed. The suturing is started at the posterior wall of the jejunum, penetrating the full-thickness of the jejunal wall from outside to inside, exciting the jejunal lumen again from the new-made opening.
  3. The sutures go straight through the pancreatic remnant from posterior to anterior, about 1 cm away from the cut end.
  4. The sutures are then placed through the full-thickness anterior wall of the jejunal loop, via the cut opening from inside the bowel lumen to outside.
  5. After completing and tying all U-sutures, the pancreatic remnant is completely invaginated into the jejunum.

  • Langrehr JM, Bahra M, Jacob D, Glanemann M, Neuhaus P. Prospective randomized comparison between a new mattress technique and Cattell (duct-to-mucosa) pancreaticojejunostomy for pancreatic resection. World J Surg. 2005;29:1111-9.