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

2017-08-16T15:25:13+00:00 Technique 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. […]

Purse-string suturing technique

2017-08-16T15:24:24+00:00 Technique 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. […]

Pair watch suturing technique

2017-08-16T15:23:41+00:00 Technique 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. […]

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. […]