Duct-to-mucosa combined with invagination

A small transverse incision of about 5 mm is made in the full-thickness of the posterior gastric wall. Around the new-formed opening in the posterior wall of the stomach, a purse-string suture is placed; the distance between the purse-string suture and the incision is 1.5 times the distance between the main pancreatic duct and the edge of the pancreatic cut surface.

Duct-to-mucosa combined with invagination pancreatogastrostomy

  1. A small transverse incision of about 5 mm is made in the full-thickness of the posterior gastric wall.
  2. Around the new-formed opening in the posterior wall of the stomach, a purse-string suture is placed; the distance between the purse-string suture and the incision is 1.5 times the distance between the main pancreatic duct and the edge of the pancreatic cut surface.
  3. A duct-to-mucosa anastomosis was performed between the main pancreatic duct and the gastric mucosa to form the inner suture-row.
  4. An outer suture-line was carried out by placing four sutures between the pancreatic capsule, about 2 cm away from the cut edge of the pancreas, and the seromuscular layer of the posterior gastric wall.
  5. The formerly placed purse-string suture is tightened gently, causing invagination of the pancreas, until the posterior stomach wall is properly wrapped around the pancreatic stump. Care is taken to avoid occlusion of the main pancreatic duct.

Tekst ALT
  • Kakita A, Takahashi T, Yoshida M, Furuta K. A simpler and more reliable technique of pancreatojejunal anastomosis. Surg Today. 1996;26:532-535
  • Kakita A, Yoshida M, Takahashi T. History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique. J Hepatobiliary Pancreat Surg. 2001;8:230-237
  • Osman MM, Abd El Maksoud W. Evaluation of a new modification of pancreaticogastrostomy after pancreaticoduodenectomy: anastomosis of the pancreatic duct to the gastric mucosa with invagination of the pancreatic remnant end into the posterior gastric wall for patients with cancer head of pancreas and periampullary carcinoma in terms of postoperative pancreatic fistula formation. Int J Surg Oncol. 2014;2014:490386