A posterior outer suture-row is performed between the capsule of the pancreatic stump and the seromuscular layer of the jejunum posteriorly. Opposite to the main pancreatic duct, a full-thickness incision with a length of 1 cm is made in the jejunal wall. The cut surface of the pancreatic remnant is anastomosed to the seromuscular edges of the new-formed jejunal opening.

Two-layered duct-to-mucosa pancreatojejunostomy in case of a small pancreatic duct

  1. A posterior outer suture-row is performed between the capsule of the pancreatic stump and the seromuscular layer of the jejunum posteriorly.
  2. Opposite to the main pancreatic duct, a full-thickness incision with a length of 1 cm is made in the jejunal wall.
  3. The cut surface of the pancreatic remnant is anastomosed to the seromuscular edges of the new-formed jejunal opening. The sutures are placed circumferentially and pass straight from the cut surface of the pancreatic parenchyma, 1 cm in diameter around the main pancreatic duct, via the incision on the jejunum through all jejunal layers. Consequently, a ‘duct-to-mucosa-like’ anastomosis of 1 cm in diameter is constructed between the pancreatic parenchyma and the jejunal mucosa, with the small pancreatic duct in the middle of the anastomosis.
  4. The outer suture-row is completed between the capsule of the pancreatic stump and the seromuscular layer of the jejunum anteriorly.

  • Sari YS, Koc O, Tunali V, Tomaoglu K. Choice of the optimal pancreaticojejunal anastomosis technique: how can we improve patient safety in pancreatic surgery? J Hepatobiliary Pancreat Surg. 2008;15:479-482.