Binding purse-string-mattress technique

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

  1. Through the full-thickness of the posterior gastric wall, a transverse incision of 2 cm in length is made.
  2. 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.
  3. 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.
  4. Through the anterior gastrotomy, a full-thickness purse-string suture in placed around the incision in the posterior wall of the stomach.
  5. The pancreatic remnant is gently pulled into the stomach, using two traction sutures on both the cranial and caudal ends of the pancreatic remnant.
  6. 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.  
  7. Care is taken to avoid injury to the main pancreatic duct.
  8. 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.