The seromuscular layer of the first 2-3 cm of the jejunal cut end is removed before the anastomosis is performed, preserving the jejunal mucosa. The pancreatic capsule, about 2 cm away from the cut margin, is anastomosed to the seromuscular coat of the jejunum posteriorly.

Two-layered invagination end-to-end pancreatojejunostomy with stripping of the proximal seromuscular layer

  1. The seromuscular layer of the first 2-3 cm of the jejunal cut end is removed before the anastomosis is performed, preserving the jejunal mucosa.
  2. The pancreatic capsule, about 2 cm away from the cut margin, is anastomosed to the seromuscular coat of the jejunum posteriorly.
  3. Sutures are circumferentially placed between the edge of the pancreatic stump and the preserved mucosal edge of the jejunum.
  4. The anastomosis is completed by performing an anterior outer suture-row between the anterior sides of the pancreatic capsule and seromuscular layer of the jejunum, causing invagination of the first 2 cm of the pancreas into the jejunum.

  • Maki HS, Kolts RL, Kuehner ME. Prevention of pancreatic fistula by modified pancreaticojejunal anastomosis. Am J Surg. 1990;160:533-534.
  • Pedrazzoli S, Sperti C, Pasquali C. An easier technique for end to end pancreaticojejunostomy. HPB Surg. 1996;9:141-143.