One-layered technique 4

From outside the anterior pancreatic capsule, 1-2 cm away from the cut end, 3-4 sutures pass straight through the anterior pancreatic parenchyma to inside the lumen of the main pancreatic duct. These sutures are not tied, but kept separately. A small incision, with a size comparable to the size of the pancreatic duct, is made in the full-thickness of the proximal jejunal wall, about 4-5 cm away from the jejunum stump.

One-layered duct-to-mucosa end-to-side pancreatojejunostomy

  1. From outside the anterior pancreatic capsule, 1-2 cm away from the cut end, 3-4 sutures pass straight through the anterior pancreatic parenchyma to inside the lumen of the main pancreatic duct. These sutures are not tied, but kept separately.
  2. A small incision, with a size comparable to the size of the pancreatic duct, is made in the full-thickness of the proximal jejunal wall, about 4-5 cm away from the jejunum stump.
  3. The posterolateral part of the jejunal wall incision is sutured to the posterolateral part of main pancreatic duct, using 5-7 sutures. Each suture first penetrates the full-thickness of posterolateral bowel wall from outside to inside the jejunal lumen and exits the jejunum via the new-formed opening. Next, the needling is directed from inside the lumen of the main pancreatic duct, straight through the posterolateral pancreatic parenchyma, to outside the pancreatic capsule again 1-2 away from the cut end. These sutures are tied gently.
  4. The preplaced anterior sutures are now used to anastomose the anterior part of the pancreas to the anterior wall of the jejunum. The sutures penetrate the full-thickness of the bowel wall from within the jejunal lumen (via the jejunal incision) to outside.
  5. The anastomosis is completed by tying the anterior sutures. Consequently, a one-layered anastomosis between the pancreatic duct and jejunal mucosa is completed.

  • Hu BY, Leng JJ, Wan T, Zhang WZ. Application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy. World J Gastrointest Surg. 2015;7:335-344.
  • Marangoni G, Morris-Stiff G, Deshmukh S, Hakeem A, Smith AM. A modern approach to teaching pancreatic surgery: stepwise pancreatoduodenectomy for trainees. J Gastrointest Surg. 2012;16:1597-1604.