Through the full-thickness of the posterior gastric wall, a transverse incision of 2 cm in length is made. A transverse full-thickness incision of 2 cm in length is applied in the anterior wall of the stomach, opposite to the posterior wall incision.
Transgastric pancreatogastrostomy with one binding purse-string and two transfixing mattress sutures
- Through the full-thickness of the posterior gastric wall, a transverse incision of 2 cm in length is made.
- A transverse full-thickness incision of 2 cm in length is applied in the anterior wall of the stomach, opposite to the posterior wall incision.
- The anastomosis is carried out using one binding purse-string suture and two transfixing mattress sutures, placed between the pancreatic stump and the posterior gastric wall.
- Through the anterior gastrotomy, a full-thickness purse-string suture in placed around the incision in the posterior wall of the stomach.
- The pancreatic remnant is gently pulled into the stomach, using two traction sutures on both the cranial and caudal ends of the pancreatic remnant.
- Two mattress sutures are placed in U-like fashion, one on each side of the main pancreatic duct. Two suture-threads with a straight needle on both ends are used: all four needles are placed from inside the gastric cavity to outside through the posterior gastric wall at the caudal side of the incision, just a few mm above the purse-string suture. Next, the needles penetrate the full-thickness of the pancreatic parenchyma from posterior to anterior and then going back to the gastric lumen through the posterior gastric wall cranial from the incision.
- Care is taken to avoid injury to the main pancreatic duct.
- The anterior gastrotomy is closed.
- Heeger K, Fendrich V, Waldmann J, Langer P, Kanngiesser V, Bartsch DK. Reduced complication rate after modified binding purse-string-mattress sutures pancreatogastrostomy versus duct-to-mucosa pancreaticojejunostomy. Surgeon. 2013;11:246-252.
- Bartsch DK, Langer P, Kanngiesser V, Fendrich V, Dietzel K. A simple and safe anastomosis for pancreatogastrostomy using one binding purse-string and two transfixing mattress sutures. Int J Surg Oncol. 2012;2012:718637.
