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
- 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.
- 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.
- 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.
- 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.