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Journal of Hepato-Biliary-Pancreatic Sciences

, Volume 19, Issue 2, pp 125–130 | Cite as

Pancreaticojejunostomy without stent (with video)

  • Takashi HatoriEmail author
Topics Highly advanced surgery in the hepatobiliary and pancreatic field (Pancreatic Chapter)

Abstract

There is a high risk of anastomotic leakage following pancreaticojejunostomy after pancreaticoduodenectomy or middle pancreatectomy in patients with a normal soft pancreas because of the abundant exocrine function. Therefore, pancreaticojejunostomy is generally performed using a stent tube (stented method). However, pancreaticojejunostomy with a certain duct-to-mucosa anastomosis does not always require a stent tube even in patients with a normal soft pancreas. We have performed pancreaticojejunostomy with duct-to-mucosa anastomosis without a stent tube (nonstented method) and obtained good results. The objective of this technique is to maintain adequate patency of the anastomosis using a fine atraumatic needle and monofilament suture. The pancreas, including the pancreatic duct, is sharply transected with a scalpel. Any arterial bleeding points on the pancreatic cut end are repaired with fine nonabsorbable sutures. The end-to-side anastomosis between the pancreas and jejunum consists of two layers of sutures. The outer layer is composed of the capsular parenchyma of the pancreas and the jejunal seromuscularis, and the inner layer is composed of the pancreatic duct with an adequate pancreatic parenchyma and the whole jejunal wall. Complete pancreaticojejunostomy using duct-to-mucosa anastomosis does not require a stent tube. This nonstented method can be considered one of the basic procedures for pancreaticojejunostomy because of its safety and reliability.

Keywords

Pancreatic reconstruction Pancreaticojejunostomy without stent Duct-to-mucosa anastomosis Pancreaticoduodenectomy Middle pancreatectomy 

Notes

Conflict of interest

I have no conflict of interest.

Supplementary material

Supplementary material 1 (MPG 16346 kb)

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Copyright information

© Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011

Authors and Affiliations

  1. 1.Department of Surgery, Institute of GastroenterologyTokyo Women’s Medical UniversityTokyoJapan

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