Double purse-string duct-to-mucosa

A full-thickness incision is made in the posterior wall of the stomach, opposite to the pancreatic stump, with a size 1 cm less than the diameter of the pancreas. Around the incision, two seromuscular purse-string sutures are placed concentrically, respectively an inner and outer purse-string suture, about 1 cm apart from each other.

Double purse-string duct-to-mucosa transgastric pancreatogastrostomy

  1. A full-thickness incision is made in the posterior wall of the stomach, opposite to the pancreatic stump, with a size 1 cm less than the diameter of the pancreas.
  2. Around the incision, two seromuscular purse-string sutures are placed concentrically, respectively an inner and outer purse-string suture, about 1 cm apart from each other.
  3. A gastrotomy is performed in the anterior gastric wall or, in case of a classic Whipple, the open stump of the distal stomach is used for the anastomosis procedure.
  4. Using two traction sutures, applied at the superior and inferior edges of the pancreatic stump, the pancreas is invaginated into the gastric cavity through the opening in the posterior gastric wall, using the anterior gastrotomy or open distal gastric stump.
  5. The two purse-string sutures are tightened gently; care is taken to avoid occlusion of the main pancreatic duct.
  6. From within the gastric lumen, an additional suture-row is applied between the pancreatic capsule from the invaginated pancreatic remnant and the gastric mucosa.
  7. The anterior gastrotomy is closed or the clamp is replaced on the distal gastric stump.

  • Addeo P, Rosso E, Fuchshuber P, et al. Double purse-string telescoped pancreaticogastrostomy: an expedient, safe, and easy technique. J Am Coll Surg. 2013;216:e27-33.