Duct-to-mucosa technique

A seromuscular incision is made in the posterior gastric wall, with a size comparable to the diameter of the pancreatic remnant. A small mucosal incision in the centre of the incised seromuscular layer, opposite of the main pancreatic duct. An outer suture-line is performed between the anterior pancreatic capsule and the seromuscular cut edge of the posterior gastric wall first.

Duct-to-mucosa pancreatogastrostomy with seromuscular incision

  1. A seromuscular incision is made in the posterior gastric wall, with a size comparable to the diameter of the pancreatic remnant.
  2. A small mucosal incision in the centre of the incised seromuscular layer, opposite of the main pancreatic duct.
  3. An outer suture-line is performed between the anterior pancreatic capsule and the seromuscular cut edge of the posterior gastric wall first.
  4. Second, the main pancreatic duct is sutured circumferentially to the mucosa around the small opening in the posterior stomach wall to form the inner, duct-to-gastric-mucosa suture-row.
  5. The anastomosis is completed by finishing the outer suture-row between the posterior pancreatic capsule and the seromuscular cut edge of the posterior gastric wall.

Duct-to-mucosa pancreatogastrostomy without seromuscular incision

An alternative way to perform the duct-to-mucosa pancreatogastrostomy is without seromuscular incision in the posterior wall of the stomach. As a result, the small opening is made in the full-thickness of the stomach wall and. Sutures from the inner, duct-to-mucosa suture-row are now circumferentially placed between the main pancreatic duct and the full-thickness of the gastric wall. The remaining aspects of the anastomosis are carried out in a same way as described above.

With seromuscular incision

  • Uemura K, Murakami Y, Sudo T, et al. Elevation of urine trypsinogen 2 is an independent risk factor for pancreatic fistula after pancreaticoduodenectomy. Pancreas. 2012;41:876-881
  • Morris DM, Ford RS. Pancreaticogastrostomy: preferred reconstruction for Whipple resection. J Surg Res. 1993;54:122-125
  • Murakami Y, Uemura K, Hayashidani Y, et al. No mortality after 150 consecutive pancreatoduodenctomies with duct-to-mucosa pancreaticogastrostomy. J Surg Oncol. 2008;97:205-209
  • Murakami Y, Uemura K, Hayashidani Y, et al. Long-term pancreatic endocrine function following pancreatoduodenectomy with pancreaticogastrostomy. J Surg Oncol. 2008;97:519-522
  • Murakami Y, Uemura K, Hayasidani Y, et al. A soft pancreatic remnant is associated with increased drain fluid pancreatic amylase and serum CRP levels following pancreatoduodenectomy. J Gastrointest Surg. 2008;12:51-56
  • Murakami Y, Uemura K, Sudo T, et al. An antecolic Roux-en Y type reconstruction decreased delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Gastrointest Surg. 2008;12:1081-1086

Without seromuscular incision

  • Tomimaru Y, Takeda Y, Kobayashi S, et al. Comparison of postoperative morphological changes in remnant pancreas between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. Pancreas. 2009;38:203-207
  • Ihse I, Axelson J, Hansson L. Pancreaticogastrostomy after subtotal pancreatectomy for cancer. Dig Surg. 1999;16:389-392
  • Conaglen PJ, Collier NA. Augmenting pancreatic anastomosis during whipple operation with fibrin glue: a beneficial technical modification? ANZ J Surg. 2014;84:266-269
  • Payne RF, Pain JA. Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy. Br J Surg. 2006;93:73-77
  • Telford GL, Mason GR. Pancreaticogastrostomy: clinical experience with a direct pancreatic-duct-to-gastric-mucosa anastomosis. Am J Surg. 1984;147:832-837