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So far Dropstep has created 37 blog entries.
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Duct-to-mucosa combined with invagination

2017-08-16T15:13:35+00:00 Technique duct-to-mucosa-combined-with-invagination-pancreatogastrostomy|

A small transverse incision of about 5 mm is made in the full-thickness of the posterior gastric wall. Around the new-formed opening in the posterior wall of the stomach, a purse-string suture is placed; the distance between the purse-string suture and the incision is 1.5 times the distance between the main pancreatic duct and the edge of the pancreatic cut surface. […]

Pancreatogastrostomy using a transgastric approach

2017-01-09T22:16:23+00:00 Pancreatogastrostomy using a transgastric approach|

Techniques:

One-layered technique

  1. A vertical incision with a size slightly less than the diameter of the pancreatic stump is made in the posterior wall of the stomach.
  2. Two traction sutures are placed on the superior and inferior sides of the pancreas.
  3. Either an anterior gastrotomy is performed or, in case of a classic Whipple, the clamp is temporarily removed from the transected stomach.
  4. The pancreatic remnant is invaginated into the gastric lumen through the posterior incision, using the traction sutures.
  5. From inside the stomach, either via the anterior incision or via the transected end of the stomach, a single suture-line is performed circumferentially between the pancreatic tissue and the gastric wall.
  6. The stay sutures can be used to secure the pancreatic stump to the posterior stomach wall from the outside.
  7. The anterior incision is closed or the clamp is replaced on the distal gastric stump.

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Using two transpancreatic sutures with buttresses

  1. A gastrotomy is made in the posterior wall of the stomach, with a size about 3/4 the width of the pancreatic remnant.
  2. Two traction sutures are placed on both ends of […]

Duct-to-mucosa technique

2017-08-16T15:12:41+00:00 Technique duct-to-mucosa-pancreatogastrostomy|

A seromuscular incision is made in the posterior gastric wall, with a size comparable to the diameter of the pancreatic remnant. A small mucosal incision in the centre of the incised seromuscular layer, opposite of the main pancreatic duct. An outer suture-line is performed between the anterior pancreatic capsule and the seromuscular cut edge of the posterior gastric wall first. […]

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

2017-01-09T22:18:07+00:00 Triple-layered duct-to-mucosa end-to-side pancreatojejunostomy|

Technique:

  1. The first layer of sutures exists of an approximation between the capsule of the pancreatic remnant and the jejunal serosa posteriorly.
  2. The seromuscular coat of the jejunum is incised for a length with the same size as the diameter of the pancreatic stump.
  3. The posterior second suture-row is performed between the pancreatic cut end and the extramucosal or seromuscular layer of the jejunum.
  4. Opposite to the main pancreatic duct, an incision is made in the jejunal mucosa with a size that matches the diameter of the pancreatic duct.
  5. A duct-to-mucosa anastomosis is applied circumferentially, forming the third suture-row.
  6. The second suture-row is continued anteriorly, suturing the anterior pancreatic cut margin and the anterior seromuscular jejunal layer together.
  7. The pancreatic anastomosis is finished by completing the first layer of sutures on the anterior side of the pancreatic capsule and jejunal serosa.

Modifications:

Using two vertical mattress sutures

  1. Before the pancreatic anastomosis is performed, two vertical mattress sutures are applied on both sides of the main pancreatic duct, to consolidate the pancreas. Suture-threads with straight needles are used. The sutures are placed 2-3 mm away from […]

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

2017-01-09T22:18:23+00:00 Two-layered duct-to-mucosa end-to-side pancreatojejunostomy|

Technique:

With resection of the seromuscular wall

  1. An incision is made in the seromuscular layer of the jejunal wall, comparable with the size of the pancreatic stump.
  2. Sutures are placed between the posterior edge of the seromuscular jejunal incision and the posterior pancreatic capsule to form the posterior part of the outer suture-row.
  3. A small opening is made in the centre of the resected serosa, with a diameter that matches the diameter of the main pancreatic duct. Consequently, the jejunal mucosa is exposed at a point exactly opposite the main pancreatic duct.
  4. The inner suture-row forms the actual duct-to-mucosa anastomosis: to this purpose, the pancreatic duct is sutured to the jejunal mucosa in all directions.
  5. To complete the outer suture-row anteriorly, the anterior part of the seromuscular jejunal wall incision is anastomosed to the anterior pancreatic capsule.

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Without resection of the seromuscular wall: an alternative way to perform the two-layered duct-to-mucosa end-to-side pancreatojejunostomy is without seromuscular incision in the jejunal wall. As a result, the small opening opposite to the pancreatic duct is made in the full-thickness of the jejunal wall. Sutures from the inner, duct-to-mucosa suture-row are now circumferentially placed between the main pancreatic duct and the full-thickness […]