End-to-end pancreatojejunostomy – 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

Triple-layered invagination end-to-end pancreatojejunostomy

loisdaamen2017-01-09T22:31:15+01:00Triple-layered invagination end-to-end pancreatojejunostomy|

Lees meer

With three overlapping U-sutures

Dropstep2017-08-16T14:33:49+02:00Technique triple-layered invagination end-to-end pancreatojejunostomy|

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. […]

Lees meer

Using two transpancreatic sutures with buttresses

Dropstep2017-08-16T14:12:39+02:00Technique one-layered-invagination-end-to-end-pancreatojejunostomy|

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. […]

Lees meer

Purse-string suturing technique

Dropstep2017-08-16T14:17:55+02:00Technique one-layered-invagination-end-to-end-pancreatojejunostomy|

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. […]

Lees meer

Overlapping transpancreatic U-suturing technique

Dropstep2017-08-16T14:19:01+02:00Technique one-layered-invagination-end-to-end-pancreatojejunostomy|

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. […]

Lees meer

With stripping of the proximal mucosa (mucosectomy)

Dropstep2017-08-16T14:19:55+02:00Technique one-layered-invagination-end-to-end-pancreatojejunostomy|

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. […]

Lees meer

With inversion of the jejunum (telescoping technique)

Dropstep2017-08-16T14:21:04+02:00Technique one-layered-invagination-end-to-end-pancreatojejunostomy|

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. […]

Lees meer

Mesh-reinforced

Dropstep2017-08-16T14:23:01+02:00Modifications one-layered-invagination-end-to-end-pancreatojejunostomy, Technique one-layered-invagination-end-to-end-pancreatojejunostomy|

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. […]

Lees meer

One-layered technique

Dropstep2017-08-16T14:29:13+02:00Technique one-layered-invagination-end-to-end-pancreatojejunostomy|

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. […]

Lees meer