A vertical incision with a size slightly less than the diameter of the pancreatic stump is made in the posterior wall of the stomach. Two traction sutures are placed on the superior and inferior sides of the pancreas. Either an anterior gastrotomy is performed or, in case of a classic Whipple, the clamp is temporarily removed from the transected stomach.

One-layered transgastric pancreatogastrostomy

  1. A vertical incision with a size slightly less than the diameter of the pancreatic stump is made in the posterior wall of the stomach.
  2. Two traction sutures are placed on the superior and inferior sides of the pancreas.
  3. Either an anterior gastrotomy is performed or, in case of a classic Whipple, the clamp is temporarily removed from the transected stomach.
  4. The pancreatic remnant is invaginated into the gastric lumen through the posterior incision, using the traction sutures.
  5. From inside the stomach, either via the anterior incision or via the transected end of the stomach, a single suture-line is performed circumferentially between the pancreatic tissue and the gastric wall.
  6. The stay sutures can be used to secure the pancreatic stump to the posterior stomach wall from the outside.
  7. The anterior incision is closed or the clamp is replaced on the distal gastric stump.

  • Dill-Russell AS. Pancreaticogastrostomy. Lancet. 1952;1:589-590
  • Gupta S. Pancreaticogastrostomy: A simplified technique. J Surg Oncol. 1994;56:249-250