A simpler and more reliable technique of pancreatojejunal anastomosis

Abstract

We herein describe the technical aspects of our method for end-to-side style pancreatojejunal anastomosis which we have been using when performing the Whipple procedure without any anastomotic complications. The method is simple and can be applied wherever an end-to-side pancreatojejunal anastomosis is required. It consists of three steps: First, a drainage tube is inserted into the pancreatic duct. Second, a direct anastomosis between the pancreatic duct and the mucosal layer of the jejunal loop is performed. The third step, which is the unique aspect of our method, is an approximation of the jejunal wall and the pancreatic stump by a one-layer suture technique that allows us not only to reduce the number of sutures but also to eliminate some of the sophisticated manipulations required by other methods. The results of our clinical experience have indicated that the present method may be comparable in terms of technical reliability to other existing methods.

Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage

“…More objective and reproducible assessment of the anatomic features of the pancreas that can predict POPF preoperatively might be useful for surgeons. Recent reports [9, 14] revealed a unique preoperative assessment of the texture of the pancreas utilizing a time‐signal intensity curve of dynamic contrast‐enhanced magnetic resonance imaging, which proved to be a significant predictor of POPF.…”

“…Then the anastomosis was formed between the pancreatic duct and the entire jejunal wall using eight interrupted 6–0 absorbable monofilament sutures (PDS‐II, ETHICON Inc., Bridgewater, NJ). A one‐layer suture technique [14] was used to approximate the pancreatic stump to the jejunal wall. Polyvinyl chloride tubes (7.5‐F in diameter; Sumitomo Bakelite, Tokyo, Japan) were inserted as internal stents in all cases regardless of the texture of the pancreatic remnant or the size of the pancreatic duct.…”

Totally laparoscopic pancreaticoduodenectomy for locally advanced gastric cancer

“…However, the morbidity relating to the pancreatic fistula was nil. Although a better technique for pancreaticojejunal anastomosis still remains to be validated especially for such a soft pancreas, several authors suggest that both external drainage and invagination may reduce the rate of pancreatic fistula [14,15]. We feel that the high quality of laparoscopic view with a well-lighted and magnificent visualization would help the surgeons to safely insert the drainage tube into the nondilated pancreatic duct and obtain appropriate approximation between the pancreas stumps.…”

Laparoscopic pancreatoduodenectomy combined with a novel self-assessment system and feedback discussion: a phase 1 surgical trial following the IDEAL guidelines

“…Pancreatojejunostomy was done via the interrupted duct-tomucosa anastomosis and modified Kakita's anastomosis method with an external drainage tube [16].…”