One-layered technique

The pancreatic remnant is invaginated into the jejunal loop for 2-4 cm and sutured all around. Stitches are placed between the seromuscular coat of the jejunum and the pancreatic capsule. For invagination of the pancreatic stump, two traction sutures are placed across the superior and inferior cut ends.

One-layered invagination end-to-end pancreatojejunostomy

  1. The pancreatic remnant is invaginated into the jejunal loop for 2-4 cm and sutured all around.
  2. Stitches are placed between the seromuscular coat of the jejunum and the pancreatic capsule.
  3. For invagination of the pancreatic stump, two traction sutures are placed across the superior and inferior cut ends. The traction sutures can be sewn directly onto the pancreatic remnant, or two sutures can be placed on the cut edges to form a loop, through which the traction sutures are passed.
  4. The long strands of each of the traction sutures are inserted through the open jejunal lumen to the outside of respectively the cranial and caudal side of the jejunal wall, approximately 2-4 cm from the cut end of the jejunum, or the long strands can be pulled out from the hepaticojejunostomy incision.
  5. Careful traction on these sutures, as well as gently pulling the cut end of the jejunum in the opposite direction over the pancreas, provides invagination of the pancreatic stump into the jejunal lumen.
  6. The traction sutures are fixed onto the jejunal wall, or pulled out.
  7. Either continuous or interrupted sutures are placed between the cut end of the jejunum and the pancreatic parenchyma.

  • Caronna R, Peparini N, Cosimo Russillo G, Antonio Rogano A, Dinatale G, Chirletti P. Pancreaticojejuno anastomosis after pancreaticoduodenectomy: brief pathophysiological considerations for a rational surgical choice. Int J Surg Oncol. 2012;2012:636824.
  • Chen HW, Lai EC, Su SY, Cai YF, Zhen ZJ, Lau WY. Modified technique of pancreaticojejunal anastomosis with invagination following pancreaticoduodenectomy: a cohort study. World J Surg. 2008;32:2695-2700.
  • Brewer MS. Management of the pancreatic stump during the Whipple operation. Am J Surg. 1996;171:438
  • Dong X, Zhang B, Kang MX, Chen Y, Guo QQ, Wu YL. Analysis of pancreatic fistula according to the International Study Group on Pancreatic Fistula classification scheme for 294 patients who underwent pancreaticoduodenectomy in a single center. Pancreas. 2011;40:222-228.