Using two transpancreatic sutures with buttresses

2017-08-16T15:07:02+00:00 Technique pancreatogastrostomy-using-a-transgastric-approach|

A gastrotomy is made in the posterior wall of the stomach, with a size about 3/4 the width of the pancreatic remnant. Two traction sutures are placed on both ends of the pancreas. An anterior gastrotomy is performed, just above the posterior incision. Using the two traction sutures, the pancreatic stump is invaginated into the gastric lumen, through the posterior gastrotomy. […]

Pancreatogastrostomy using a transgastric approach

2017-01-09T22:16:23+00:00 Pancreatogastrostomy using a transgastric approach|

Techniques:

One-layered technique

  1. A vertical incision with a size slightly less than the diameter of the pancreatic stump is made in the posterior wall of the stomach.
  2. Two traction sutures are placed on the superior and inferior sides of the pancreas.
  3. Either an anterior gastrotomy is performed or, in case of a classic Whipple, the clamp is temporarily removed from the transected stomach.
  4. The pancreatic remnant is invaginated into the gastric lumen through the posterior incision, using the traction sutures.
  5. From inside the stomach, either via the anterior incision or via the transected end of the stomach, a single suture-line is performed circumferentially between the pancreatic tissue and the gastric wall.
  6. The stay sutures can be used to secure the pancreatic stump to the posterior stomach wall from the outside.
  7. The anterior incision is closed or the clamp is replaced on the distal gastric stump.

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Using two transpancreatic sutures with buttresses

  1. A gastrotomy is made in the posterior wall of the stomach, with a size about 3/4 the width of the pancreatic remnant.
  2. Two traction sutures are placed on both ends of […]