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. […]
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. […]
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 This suture penetrates the jejunal wall from outside to inside about 1 cm distal to the cut edge and is then withdrawn from the jejunal opening. […]
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. […]
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. […]
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. […]
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. […]
