Using two transpancreatic sutures with buttresses
- A gastrotomy is made in the posterior wall of the stomach, with a size about 3/4 the width of the pancreatic remnant.
- Two traction sutures are placed on both ends of the pancreas.
- An anterior gastrotomy is performed, just above the posterior incision.
- Using the two traction sutures, the pancreatic stump is invaginated into the gastric lumen, through the posterior gastrotomy.
- The anastomosis is performed using two transpancreatic sutures with buttresses on the superior and inferior borders of the pancreas, placed via the anterior incision; two threads with a straightened needle on both ends and four buttresses were used.
- The first suture was placed from within the gastric lumen to outside on one side of the superior corner of the gastrotomy, through the full-thickness of the stomach wall, then from posterior to anterior through the superior pancreatic parenchyma and back to inside the gastric lumen again through the full-thickness of the stomach wall on the other side of the superior corner of the gastrotomy. The second suture was placed in a same manner at the inferior corner of the gastrotomy.
- The four buttresses (two on each side) are inserted through the needles and the sutures are tied.
- The anterior gastrotomy is closed.