Purse-string suturing technique

The seromuscular layer of the jejunum is incised with a width comparable to the diameter of the pancreatic remnant. A purse-string suture is performed in the mucosa at the centre of the seromuscular incision. A stent tube is placed in the main pancreatic duct and fixed with a stay suture; the other tip of the tube is introduced into the jejunal lumen through the mucosa in the middle of the preplaced mucosal purse-string suture and secured by ligating the purse-string.

Two-layered duct-to-mucosa pancreatojejunostomy using a purse-string suture

  1. The seromuscular layer of the jejunum is incised with a width comparable to the diameter of the pancreatic remnant.
  2. A purse-string suture is performed in the mucosa at the centre of the seromuscular incision.
  3. A stent tube is placed in the main pancreatic duct and fixed with a stay suture; the other tip of the tube is introduced into the jejunal lumen through the mucosa in the middle of the preplaced mucosal purse-string suture and secured by ligating the purse-string. The ligated purse-string forms the second stay suture.
  4. The posterior side of the pancreatic capsule is anastomosed to the posterior seromuscular layer of the jejunal wall.
  5. The two stay sutures are tied together for approximating the ductal cut end and the jejunal mucosa. No further sutures are used for duct-to-mucosa contact.
  6. The anastomosis is completed by suturing the pancreatic capsule to the seromuscular wall of the jejunum anteriorly.

  • Hakamada K, Narumi S, Toyoki Y, et al. An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture. World J Gastroenterol. 2008;14:1091-1096.