Using two hemstitch sutures

A seromuscular incision is made in the posterior wall of the stomach, with a size similar to the diameter of the pancreatic stump; the mucosa is remained intact at first. The first hemstitch suture is applied in the seromuscular layer of the gastric wall around the seromuscular incision.

Transgastric pancreatogastrostomy using two hemstitch sutures

  1. A seromuscular incision is made in the posterior wall of the stomach, with a size similar to the diameter of the pancreatic stump; the mucosa is remained intact at first.
  2. The first hemstitch suture is applied in the seromuscular layer of the gastric wall around the seromuscular incision.
  3. In the centre of the incised seromuscular layer, a lateral stab incision of about 3 cm is carried out in the mucosa of the posterior stomach wall.
  4. The second hemstitch suture is performed in the mucosal layer of the gastric wall around the mucosal incision.
  5. A gastrotomy is made in the anterior gastric wall or, in case of a classic Whipple, the open distal gastric stump is used for the anastomosis procedure.
  6. The pancreatic remnant is invaginated into the gastric cavity through the anterior gastrotomy or via the distal open end of the stomach, using two traction sutures.
  7. The outer, seromuscular hemstitch is tied gently around the pancreas at first, as low as possible.
  8. Second, the inner, mucosal hemstitch is tied from within the gastric lumen, about 1 cm away from the cut edge of the pancreas. Care is taken to avoid occlusion of the main pancreatic duct.
  9. The anterior gastrotomy is closed or the clamp is replaced on the distal gastric stump.

  • Zhu F, Wang M, Wang X, et al. Modified technique of pancreaticogastrostomy for soft pancreas with two continuous hemstitch sutures: a single-center prospective study. J Gastrointest Surg. 2013;17:1306-1311.