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
- 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. The ligated purse-string forms the second stay suture.
- The posterior side of the pancreatic capsule is anastomosed to the posterior seromuscular layer of the jejunal wall.
- 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.
- 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.
