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
- 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.
- An incision is made in the seromuscular layer of the jejunal wall, matching the diameter of the pancreatic stump.
- 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.
- The posterior lip of the pancreatic capsule is sutured to the posterior seromuscular wall of the jejunum.
- 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.
- 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.
