Without actual gastrotomy

A pancreatic tube is inserted into the main pancreatic duct and secured with a single suture. A row of sutures is placed between the anterior edge of the pancreatic remnant and the seromuscular layer of the posterior gastric wall. A stab incision is made in the seromuscular layer of the posterior stomach wall, prior to the suture row, leaving the mucosa intact.

Pancreatogastrostomy without actual gastrotomy

  1. A pancreatic tube is inserted into the main pancreatic duct and secured with a single suture.
  2. A row of sutures is placed between the anterior edge of the pancreatic remnant and the seromuscular layer of the posterior gastric wall.
  3. A stab incision is made in the seromuscular layer of the posterior stomach wall, prior to the suture row, leaving the mucosa intact.
  4. With a needle adapted to the opposite end of the pancreatic tube, the tube is passed into the cavity of the stomach via the exposed gastric mucosa of the posterior wall, then through the anterior wall of the stomach and through the anterior abdominal wall for exteriorization of the pancreatic tube.
  5. The pancreatic tube is anchored to the anterior abdomen.
  6. The suture, placed between the main pancreatic duct and tube, is used to secure the pancreatic duct onto the gastric mucosa circumferentially.
  7. Completion of the anastomosis takes place by continuing the suture-row between the posterior pancreatic edge and the seromuscular layer of the gastric wall.

  • Murakami H, Yasue M. A vertical stomach reconstruction after pylorus-preserving pancreaticoduodenectomy. Am J Surg. 2001;181:149-152
  • Takao S, Shimazu H, Maenohara S, Shinchi H, Aikou T. Modified pancreaticogastrostomy following pancreaticoduodenectomy. Am J Surg. 1993;165:317-321