Before the anastomosis procedure is started, the pancreatic stump is prepared: the pancreatic cut surface is shaped like a ‘fish mouth’ and the pancreatic duct is protruded out of the stump for 6-8 mm. To do so, a 6-8 mm deep incision is performed circumferentially, 2-3 mm around the main duct, and the surrounding pancreatic parenchyma is removed. The cut end of the pancreas is closed with inverting sutures, excluding the protruded main pancreatic duct or so-called ‘papillary-like main pancreatic duct’
- Zhang B, Xu J, Liu C, et al. Application of “papillary-like main pancreatic duct invaginated” pancreaticojejunostomy for normal soft pancreas cases. Sci Rep. 2013;3:2068.
- Xu J, Zhang B, Shi S, et al. Papillary-like main pancreatic duct invaginated pancreaticojejunostomy versus duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: A prospective randomized trial. Surgery. 2015.