Papillary-like main pancreatic duct invaginated

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’

Papillary-like main pancreatic duct invaginated pancreatojejunostomy

  1. 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’.
  2. The posterior pancreatic capsule is sutured to the seromuscular layer of the jejunum.
  3. A small incision was made through the full-thickness of the jejunal wall, with a size similar to the diameter of the ‘papillary-like main pancreatic duct’.
  4. Via the new-formed opening in the jejunal wall, the ‘papillary-like main pancreatic duct’ is invaginated and circumferentially fixed by 4-6 sutures, placed between the periductal parenchyma (just around the ‘papillary-like main pancreatic duct’) and the edges of the jejunal wall incision (through the full-thickness of the bowel wall). Care is taken to avoid injury to the main pancreatic duct.
  5. To finish the anastomosis, the anterior pancreatic capsule is sutured to the seromuscular layer of the jejunum.

  • 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.