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So far loisdaamen has created 37 blog entries.

True duct-to-mucosa anastomosis

2017-08-16T15:21:01+00:00 Technique two-layered duct-to-mucosa end-to-side pancreatojejunostomy|

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. […]

In case of a small pancreatic duct

2017-08-16T15:20:28+00:00 Technique two-layered duct-to-mucosa end-to-side pancreatojejunostomy|

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. […]

Stump-closed

2017-08-16T15:19:37+00:00 Technique two-layered duct-to-mucosa end-to-side pancreatojejunostomy|

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. […]

Duct-to-mucosa adaptation

2017-08-16T15:30:19+00:00 Technique two-layered-invagination-end-to-side-pancreatojejunostomy|

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).

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