Triple-layered technique

The first layer of sutures exists of an approximation between the capsule of the pancreatic remnant and the jejunal serosa posteriorly. The seromuscular coat of the jejunum is incised for a length with the same size as the diameter of the pancreatic stump. The posterior second suture-row is performed between the pancreatic cut end and the extramucosal or seromuscular layer of the jejunum.

Triple-layered duct-to-mucosa pancreatojejunostomy

  1. The first layer of sutures exists of an approximation between the capsule of the pancreatic remnant and the jejunal serosa posteriorly.
  2. The seromuscular coat of the jejunum is incised for a length with the same size as the diameter of the pancreatic stump.
  3. The posterior second suture-row is performed between the pancreatic cut end and the extramucosal or seromuscular layer of the jejunum.
  4. Opposite to the main pancreatic duct, an incision is made in the jejunal mucosa with a size that matches the diameter of the pancreatic duct.
  5. A duct-to-mucosa anastomosis is applied circumferentially, forming the third suture-row.
  6. The second suture-row is continued anteriorly, suturing the anterior pancreatic cut margin and the anterior seromuscular jejunal layer together.
  7. The pancreatic anastomosis is finished by completing the first layer of sutures on the anterior side of the pancreatic capsule and jejunal serosa.

  • Ibrahim S, Tay KH, Launois B, Ta NC. Triple-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy. Dig Surg. 2006;23:296-302.
  • Su AP, Zhang Y, Ke NW, et al. Triple-layer duct-to-mucosa pancreaticojejunostomy with resection of jejunal serosa decreased pancreatic fistula after pancreaticoduodenectomy. J Surg Res. 2014;186:184-191.
  • Tsuji M, Kimura H, Konishi K, Yabushita K, Maeda K, Kuroda Y. Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy: historical study of 300 patients. Surgery. 1998;123:617-621.