A posterior row of stitches is placed between the parenchyma of the pancreatic remnant, about 1-1.5cm from the cut surface, and the seromuscular layer of the jejunum. After tying the knots of the posterior suture-row, an opening in the jejunum is made comparable to the size of the pancreatic remnant.
A full-thickness incision is made in the jejunal side wall with a size similar to the diameter of the pancreas. A purse-string suture is applied in the seromuscular layer around the new-formed opening in the jejunum. Four to five stay sutures are placed in the pancreatic capsule around the pancreatic remnant.
A purse-string suture is applied through the main pancreatic duct and the peri-ductal pancreatic parenchyma, after which the suture is brought to outside via the ductal lumen. A stent tube is inserted into the main pancreatic duct and anchored by tying the purse-string suture. Care is taken to avoid occlusion of the pancreatic duct. […]
The jejunal sidewall is opened for a size similar to the diameter of the pancreatic stump. A total of five to six U-sutures are applied following an inverted mattress suturing technique. The first three to four sutures go through the full-thickness of the posterior jejunal wall, from outside to inside, and through the seromuscular wall of the jejunum back to outside, inverting the seromuscular coat of the jejunum. […]
An incision is made in the sidewall of the jejunal loop, with a size matching the diameter of the pancreatic cut surface. The one-layered invagination end-to-side pancreatojejunostomy is performed using a mattress suturing technique. To this purpose, transpancreatic U-sutures are placed. The suturing is started at the posterior wall of the jejunum, penetrating the full-thickness of the jejunal wall from outside to inside, exciting the jejunal lumen again from the new-made opening. […]