Duct-to-mucosa technique

An incision is made in the seromuscular layer of the jejunal wall, comparable with the size of the pancreatic stump. Sutures are placed between the posterior edge of the seromuscular jejunal incision and the posterior pancreatic capsule to form the posterior part of the outer suture-row.

Two-layered duct-to-mucosa pancreatojejunostomy with seromuscular incision

  1. An incision is made in the seromuscular layer of the jejunal wall, comparable with the size of the pancreatic stump.
  2. Sutures are placed between the posterior edge of the seromuscular jejunal incision and the posterior pancreatic capsule to form the posterior part of the outer suture-row.
  3. A small opening is made in the centre of the resected serosa, with a diameter that matches the diameter of the main pancreatic duct. Consequently, the jejunal mucosa is exposed at a point exactly opposite the main pancreatic duct.
  4. The inner suture-row forms the actual duct-to-mucosa anastomosis: to this purpose, the pancreatic duct is sutured to the jejunal mucosa in all directions.
  5. To complete the outer suture-row anteriorly, the anterior part of the seromuscular jejunal wall incision is anastomosed to the anterior pancreatic capsule.

Without seromuscular incision

An alternative way to perform the two-layered duct-to-mucosa end-to-side pancreatojejunostomy is without seromuscular incision in the jejunal wall. As a result, the small opening opposite to the pancreatic duct is made in the full-thickness of the jejunal wall. Sutures from the inner, duct-to-mucosa suture-row are now circumferentially placed between the main pancreatic duct and the full-thickness of the bowel wall. The remaining aspects of the anastomosis are carried out in a same way as described above.

With resection of the seromuscular wall

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Without resection of the seromuscular wall

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