Opposite to the pancreatic stump, the jejunal wall is incised for ca. 2 cm. A seromuscular purse-string suture is performed around the new-formed opening, about 0.5 cm away from the cut edge. Next, two U-shaped mattress sutures are placed at both sides of the main pancreatic duct.
The anastomosis between the pancreas and jejunum is performed using two layers of sutures posteriorly and one anterior suture-row. First, the outer posterior layer is performed by placing sutures between the capsule and some parenchyma of the pancreatic remnant and the seromuscular layer of the jejunal wall.
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).
A posterior outer suture-row is carried out between the seromuscular coat of the jejunum and the pancreatic capsule. A full-thickness incision is made in the side wall of the jejunum, opposite to the pancreatic remnant and a few cm away from the jejunal stump, with a size similar to the diameter of the pancreas. […]