With inversion of the jejunum (telescoping technique)

An intestinal cuff is created by inverting the jejunal loop with a few sutures around the jejunal opening, before invaginating the pancreatic remnant into the jejunal lumen. Herewith, the cut surface of the pancreatic stump is covered by serosa instead of mucosa.

One-layered invagination end-to-end pancreatojejunostomy with inversion of the jejunum (telescoping technique)

  1. An intestinal cuff is created by inverting the jejunal loop with a few sutures around the jejunal opening, before invaginating the pancreatic remnant into the jejunal lumen. Herewith, the cut surface of the pancreatic stump is covered by serosa instead of mucosa.
  2. For creating the intestinal cuff, the suture needs to pass the complete jejunal wall both near the cut edge and at a point about 5-6 cm from the cut end of the jejunum. However, different suturing techniques, such as the placement of three parallel mattress sutures, are described.
  3. Next, the pancreatic stump can be invaginated and intususcepted into the formed cuff for about 2,5-3 cm, using traction sutures or other techniques.
  4. The edge of the cuff is circumferentially secured to the pancreatic capsule with a single suture-row.

  • Kusnierz K, Mrowiec S, Lampe P. A comparison of two invagination techniques for pancreatojejunostomy after pancreatoduodenectomy. Gastroenterol Res Pract. 2015;2015.
  • Rao AC, Gabriel G, Serrano J, Benedicto R. Inkwell pancreaticojejunal anastomosis after pancreaticoduodenectomy. Am J Surg. 2004;187:410-412.