loisdaamen – The Pancreatic Anastomosis

Transpancreatic invagination suturing technique

loisdaamen2018-06-06T17:47:24+02:00Technique two-layered invagination-end-to-end-pancreatojejunostomy|

Before transection of the pancreas, two hemostatic sutures are placed cranially and caudally within the pancreatic parenchyma. After resection of the specimen, the anastomosis is started, using a double armed suture. For the first invagination stitch, the needle passed through the entire pancreatic remnant from anterior to posterior, 1 cm away from the cutting edge, cranially from the main pancreatic duct.

Transpancreatic invagination suturing technique

Before transection of the pancreas, two hemostatic sutures are placed cranially and caudally within the pancreatic parenchyma.
After resection of the specimen, the anastomosis is started, using a double armed suture. For the first invagination stitch, the needle passed through the entire pancreatic remnant from anterior to posterior, 1 cm away from the cutting edge, cranially from the main pancreatic duct. The needle is then placed through the posterior seromuscular layer of the jejunum, 1.5 cm away from the stapled end. Next, the needle is passed again through the entire pancreas – from posterior to anterior – a few millimeters next to the first stitch.
A second invagination stitch is placed in a similar fashion, caudally from the main […]

Lees meer

One-layered technique 4

loisdaamen2017-08-16T15:18:46+02:00Technique 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. […]

Lees meer

Papillary-like main pancreatic duct invaginated

loisdaamen2017-08-16T15:17:33+02:00Technique duct invagination end-to-side-pancreatojejunostomy|

Before the anastomosis procedure is started, the pancreatic stump is prepared: the pancreatic cut surface is shaped like a ‘fish mouth’ and the pancreatic duct is protruded out of the stump for 6-8 mm. To do so, a 6-8 mm deep incision is performed circumferentially, 2-3 mm around the main duct, and the surrounding pancreatic parenchyma is removed. The cut end of the pancreas is closed with inverting sutures, excluding the protruded main pancreatic duct or so-called ‘papillary-like main pancreatic duct’ […]

Lees meer

Using two vertical mattress sutures

loisdaamen2017-08-16T15:28:25+02:00Technique triple-layered duct-to-mucosa end-to-side pancreatojejunostomy|

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 the pancreatic cut end and penetrate the complete pancreatic parenchyma. Care is taken to avoid injury to the main pancreatic duct. The vertical mattress sutures are tied firmly. […]

Lees meer

Triple-layered technique

loisdaamen2017-08-16T15:27:16+02:00Technique triple-layered duct-to-mucosa end-to-side pancreatojejunostomy|

The first layer of sutures exists of an approximation between the capsule of the pancreatic remnant and the jejunal serosa posteriorly. The seromuscular coat of the jejunum is incised for a length with the same size as the diameter of the pancreatic stump. The posterior second suture-row is performed between the pancreatic cut end and the extramucosal or seromuscular layer of the jejunum. […]

Lees meer

Duct-to-mucosa technique

loisdaamen2017-08-16T15:26:53+02:00Technique duct-to-mucosa, Technique two-layered duct-to-mucosa end-to-side pancreatojejunostomy|

An incision is made in the seromuscular layer of the jejunal wall, comparable with the size of the pancreatic stump. 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. […]

Lees meer

Whole-layer tightly appressed

loisdaamen2017-08-16T15:25:37+02:00Technique two-layered duct-to-mucosa end-to-side pancreatojejunostomy|

The pancreatic capsule is sutured to the seromuscular wall of the jejunum posteriorly, about 1 cm away from the pancreatic cut end. A small hole, with a diameter that matches the diameter of the main pancreatic duct, is made through the full-thickness of the jejunal wall, opposite to the pancreatic duct. […]

Lees meer

Suspension pancreatic-duct-jejunum end-to-side continuous suture

loisdaamen2017-08-16T15:25:13+02:00Technique two-layered duct-to-mucosa end-to-side pancreatojejunostomy|

The pancreatic capsule is anastomosed to the seromuscular layer of the jejunal wall posteriorly, 1-1.5 cm away from the pancreatic cut end. A full-thickness incision is made in the wall of the jejunum, with a size comparable to the diameter of the main pancreatic duct or with a size that matches the diameter of the pancreatic stump. […]

Lees meer

Purse-string suturing technique

loisdaamen2017-08-16T15:24:24+02:00Technique two-layered duct-to-mucosa end-to-side pancreatojejunostomy|

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. […]

Lees meer

Pair watch suturing technique

loisdaamen2017-08-16T15:23:41+02:00Technique two-layered duct-to-mucosa end-to-side pancreatojejunostomy|

The pair watch suturing technique contains a precise way of accomplishing a duct-to-mucosa pancreatojejunostomy, by imaging the faces of a pair of wristwatches on the jejunal hole and the main pancreatic duct during the anastomosis procedure. A small opening is made through the full-thickness of the jejunal wall, opposite the main pancreatic duct, with a size that matches the diameter of the pancreatic duct. […]

Lees meer

Over loisdaamen