An opening is made in the seromuscular side wall of the jejunum, with a size similar to the diameter of the pancreas. The Blumgart anastomosis is constructed by four to six transpancreatic U-sutures: two to three on each side of the main pancreatic duct. Suture-threads with a needle on both ends are used. […]
An outer, posterior suture-row is performed between the outer 2/3rd of the radius of the cut pancreatic gland and the seromuscular layer of the jejunal wall posteriorly. A small hole of 2-3 mm in diameter is made through the full-thickness of the jejunal wall, opposite the main pancreatic duct. The jejunal mucosa is everted in all directions and anchored to the seromuscular wall around the new-formed opening in the jejunum, using four stitches. […]
A posterior outer suture-row is performed between the capsule of the pancreatic stump and the seromuscular layer of the jejunum posteriorly. Opposite to the main pancreatic duct, a full-thickness incision with a length of 1 cm is made in the jejunal wall. The cut surface of the pancreatic remnant is anastomosed to the seromuscular edges of the new-formed jejunal opening. […]
Before the pancreatojejunal anastomosis is started, the pancreatic stump is ‘closed’. For this procedure, a stent tube is placed into the main pancreatic duct, and the cut surface of the pancreatic stump is shaped like a ‘fish-mouth’. The two lips of the fish-mouth are sutured together, closing the cut end of the pancreas, with exclusion of the pancreatic duct. […]
Opposite to the pancreatic stump, the jejunal wall is incised for ca. 2 cm. A seromuscular purse-string suture is performed around the new-formed opening, about 0.5 cm away from the cut edge. Next, two U-shaped mattress sutures are placed at both sides of the main pancreatic duct.
The anastomosis between the pancreas and jejunum is performed using two layers of sutures posteriorly and one anterior suture-row. First, the outer posterior layer is performed by placing sutures between the capsule and some parenchyma of the pancreatic remnant and the seromuscular layer of the jejunal wall.
An incision is made in the jejunal side wall with a size that matches the diameter of the pancreatic stump. At least three stitches are preplaced in both the posterior and anterior walls of the main pancreatic duct. The inner suture-row is circumferentially performed between the full-thickness of the jejunum and the pancreatic parenchyma of the cut edge; the six formerly placed ductal sutures are integrated in the posterior and anterior parts of the inner suture-line (respectively three in the posterior part and three in the anterior part).
A posterior outer suture-row is carried out between the seromuscular coat of the jejunum and the pancreatic capsule. A full-thickness incision is made in the side wall of the jejunum, opposite to the pancreatic remnant and a few cm away from the jejunal stump, with a size similar to the diameter of the pancreas. […]