Stump-closed

Before the pancreatojejunal anastomosis is started, the pancreatic stump is ‘closed’. For this procedure, a stent tube is placed into the main pancreatic duct, and the cut surface of the pancreatic stump is shaped like a ‘fish-mouth’. The two lips of the fish-mouth are sutured together, closing the cut end of the pancreas, with exclusion of the pancreatic duct.

Stump-closed two-layered duct-to-mucosa pancreatojejunostomy

  1. Before the pancreatojejunal anastomosis is started, the pancreatic stump is ‘closed’. For this procedure, a stent tube is placed into the main pancreatic duct, and the cut surface of the pancreatic stump is shaped like a ‘fish-mouth’. The two lips of the fish-mouth are sutured together, closing the cut end of the pancreas, with exclusion of the pancreatic duct.
  2. An incision is made in the seromuscular layer of the jejunal wall, matching the diameter of the pancreatic stump.
  3. A small hole of 2-3 mm in diameter is made in the centre of the seromuscular incision, through which the pancreatic stent tube is inserted.
  4. The posterior lip of the pancreatic capsule is sutured to the posterior seromuscular wall of the jejunum.
  5. Periductal stitches are applied circumferentially around the pancreatic stent tube, between the periductal pancreatic parenchyma and the edge of the small, new-formed jejunal hole, to secure the stent tube firmly.
  6. The anterior lip of the pancreas is anastomosed to the anterior seromuscular jejunal wall, finishing the stump-closed pancreatojejunostomy.

  • Liu C, Long J, Liu L, et al. Pancreatic stump-closed pancreaticojejunostomy can be performed safely in normal soft pancreas cases. J Surg Res. 2012;172:e11-7.