With three overlapping U-sutures
Mucosectomy is performed on the distal 2 cm of the jejunal stump before the anastomotic procedure is started. The pancreatic capsule is anchored to the full-thickness of the jejunal wall. To do so, two sutures are applied to the superior and inferior margins of the pancreatic capsule, 1.5 cm away from the cut end of the pancreas. […]
Using two transpancreatic sutures with buttresses
The pancreatic stump is invaginated into the jejunal loop, using traction sutures or other techniques. Two transpancreatic sutures with buttresses are inserted for fixation of the jejunal wall onto the intususcepted pancreatic remnant, using two suture-threads with a needle on both strain ends. […]
Purse-string suturing technique
The purse-string suturing-technique can be performed using a preloaded, reusable mechanical purse-string device, or can be hand-sewn, existing of a running suture. The purse-string is applied circumferentially to the cut end of the proximal jejunum. […]
Overlapping transpancreatic U-suturing technique
The pancreatic stump is invaginated into the jejunal lumen by two to three transpancreatic U-sutures, overlapping each other. The first U-suture is started at the mesenteric side of the anterior jejunum. This suture penetrates the jejunal wall from outside to inside about 1 cm distal to the cut edge and is then withdrawn from the jejunal opening. […]
With stripping of the proximal mucosa (mucosectomy)
Mucosectomy of the distal jejunum can be performed before invagination of the pancreatic stump. The mucosal layer of the jejunum is exposed by everting the distal part of the jejunum for about 3 cm. This can be done using two sutures, placed between the seromuscular coat near the jejunal cut end and the jejunal wall about 6 cm away from the cut margin. […]
With inversion of the jejunum (telescoping technique)
An intestinal cuff is created by inverting the jejunal loop with a few sutures around the jejunal opening, before invaginating the pancreatic remnant into the jejunal lumen. Herewith, the cut surface of the pancreatic stump is covered by serosa instead of mucosa. […]
Mesh-reinforced
The edge of the stump is tightly wrapped around using an absorbable or non-absorbable mesh with a width of 1.0-1.5 cm and a length that matches the circumferential length of the pancreas. The mesh is placed about 1.0 cm from the cut margin of the pancreas and can be fixed onto the pancreatic capsule with a few stitches. […]
One-layered technique
The pancreatic remnant is invaginated into the jejunal loop for 2-4 cm and sutured all around. Stitches are placed between the seromuscular coat of the jejunum and the pancreatic capsule. For invagination of the pancreatic stump, two traction sutures are placed across the superior and inferior cut ends. […]
Binding pancreaticojejunostomy
The jejunal stump is everted for 3 cm, by suturing the jejunal free margin loosely to a point at the jejunal loop 6 cm from the cut edge. This leaves the mucosa exposed for excising. Mucosectomy of the everted part of the jejunum is applied. The pancreatic remnant is sutured to the mucosal margin of the jejunum in a circulair fashion. […]