Sealing combined with duct-to-mucosa

A small opening is made in the jejunal wall, with a size similar to the diameter of the main pancreatic duct. Suture threads with a needle on both sides are used to perform the anastomosis. The sutures are placed one by one, starting with the posterior suture-row. From inside the lumen of the main pancreatic duct, the needle is passed through the posterior pancreatic parenchyma, exiting the pancreas at the posterior side, approximately 0.5 cm away from the cut margin.

Sealing pancreatojejunostomy in combination with duct parenchyma to mucosa seromuscular one-layered end-to-side anastomosis

  1. A small opening is made in the jejunal wall, with a size similar to the diameter of the main pancreatic duct.
  2. Suture threads with a needle on both sides are used to perform the anastomosis.
  3. The sutures are placed one by one, starting with the posterior suture-row. From inside the lumen of the main pancreatic duct, the needle is passed through the posterior pancreatic parenchyma, exiting the pancreas at the posterior side, approximately 0.5 cm away from the cut margin.
  4. The needle on the other side of the suture thread is placed from inside the jejunal lumen to outside the jejunal wall posteriorly, through the full-thickness of the bowel wall. The distance from the cut edge of the jejunum depends on the thickness of the pancreas, to ensure a good fit between the surfaces of the pancreatic stump and the jejunal serosa.
  5. The anterior suture-row is carried out in a same way, anastomosing the pancreas and jejunum all around. All knots are tied on the outside.
  6. Additional sutures are placed between the pancreatic capsule and the seromuscular coat of the jejunum on the inferior and superior borders of the anastomosis.

hier de beschrijving

  • Zhang L, Li Z, Wu X, Li Y, Zeng Z. Sealing pancreaticojejunostomy in combination with duct parenchyma to mucosa seromuscular one-layer anastomosis: A novel technique to prevent pancreatic fistula after pancreaticoduodenectomy. J Am Coll Surg. 2015;220:e71-e77.