The pair watch suturing technique contains a precise way of accomplishing a duct-to-mucosa pancreatojejunostomy, by imaging the faces of a pair of wristwatches on the jejunal hole and the main pancreatic duct during the anastomosis procedure. A small opening is made through the full-thickness of the jejunal wall, opposite the main pancreatic duct, with a size that matches the diameter of the pancreatic duct.

Two-layered duct-to-mucosa pancreatojejunostomy using a pair watch suturing technique

  1. The pair watch suturing technique contains a precise way of accomplishing a duct-to-mucosa pancreatojejunostomy, by imaging the faces of a pair of wristwatches on the jejunal hole and the main pancreatic duct during the anastomosis procedure.
  2. A small opening is made through the full-thickness of the jejunal wall, opposite the main pancreatic duct, with a size that matches the diameter of the pancreatic duct.
  3. The first suture is placed between 9 o’clock on the pancreatic ductal side and 3 o’clock on the jejunal side. Following this pattern, a total of seven and five sutures are placed in the posterior and anterior walls, respectively. Therewith, the inner anastomotic layer between the main pancreatic duct and the jejunal mucosa exists of twelve stitches, regardless of the calibre of the pancreatic duct.
  4. A second, outer layer is performed between the pancreatic capsule and seromuscular coat of the jejunum, using 5-7 sutures on both the anterior and posterior sides.
  5. The pancreatic anastomosis is completed by adding one backstopping stitch on both the caudal and cranial corners of the anastomosis.

  • Azumi Y, Isaji S. Stented pancreaticojejunostomy (with video). J Hepatobiliary Pancreat Sci. 2012;19:116-124.
  • Azumi Y, Isaji S, Kato H, et al. A standardized technique for safe pancreaticojejunostomy: Pair-Watch suturing technique. World J Gastrointest Surg. 2010;2:260-264.