With three overlapping U-sutures

Mucosectomy is performed on the distal 2 cm of the jejunal stump before the anastomotic procedure is started. The pancreatic capsule is anchored to the full-thickness of the jejunal wall. To do so, two sutures are applied to the superior and inferior margins of the pancreatic capsule, 1.5 cm away from the cut end of the pancreas.

Triple-layered invagination end-to-end pancreatojejunostomy with three overlapping U-sutures

  1. Mucosectomy is performed on the distal 2 cm of the jejunal stump before the anastomotic procedure is started.
  2. The pancreatic capsule is anchored to the full-thickness of the jejunal wall. To do so, two sutures are applied to the superior and inferior margins of the pancreatic capsule, 1.5 cm away from the cut end of the pancreas. The sutures are then placed through the jejunal wall from inside the jejunal lumen, entering via the open end of the jejunum, to outside 1 cm away from the cut margin. After tying these sutures, the pancreatic stump is pre-invaginated into the jejunal seromuscular coat for 2.5 cm.
  3. The pancreatojejunal anastomosis is performed by the placement of three overlapping U-sutures: two semi-transpancreatic U-sutures and one total-transpancreatic U-suture. The first two semi-transpancreatic U-sutures are placed through the anterior jejunal wall, respectively superior and inferior from the main pancreatic duct, about 0.5 cm from the cut jejunal end. Next, these sutures go straight through the pancreatic parenchyma, from anterior to posterior, and through the posterior jejunal wall. The semi-transpancreatic sutures are kept separately for later completion of the anastomosis.
  4. The total-transpancreatic U-suture is applied through the anterior wall of the jejunum, just above the superior semi-transpancreatic U-suture, again through the full-thickness of the pancreatic remnant and the posterior jejunal wall, then going back from posterior to anterior just beneath the inferior semi-transpancreatic U-suture. Herewith, the total-transpancreatic U-suture overlaps the two semi-transpancratic U-sutures.
  5. The three sutures are tied gently. One of the three pairs of suture-threads is used for final binding of the pancreatojejunal attachments to reinforce the anastomotic site.

  • Tao Li MD, Li-Xi Luo MD, Chun Zhang MD, Gang-Pu Wang MD, Ze-Ting Chen MD, Zhi-Chao Jiang MD, Xiang-Yu Wang MD & Xu-Ting Zhi MD. End-to-end invaginated pancreaticojejunostomy with three overlapping U-Sutures––a safe and simple method of pancreaticoenteric anastomosis. J Invest Surg. 2015;28:115-119.