Invaginating Pancreaticojejunostomy: How I Do It

Abstract

Pancreaticoduodenectomy (PD) is a surgical procedure designed to treat benign and malignant diseases of the periampullary region such as chronic pancreatitis and pancreatic cancer. The operation is conducted in two parts, the first of which is the extirpative phase, which includes the removal of the pancreatic head, neck, and uncinate process, distal common bile duct, and duodenum. This is followed by the reconstruction phase where the duodenum, bile duct, and pancreas remnant are anastomosed to the jejunum. The technique for the pancreaticojejunostomy (PJ) anastomosis will be the subject of this chapter.

The PJ is often termed the “Achilles heel” of the operation because it is the aspect associated with the highest occurrence of leakage and the ensuing potential for intra-abdominal sepsis. Leakage of the PJ is also a driver of a variety of other associated complications, such as delayed gastric emptying, intestinal ileus, and wound infection, among others. The two most common techniques in current practice for PJ construction are the invaginated and the duct-to-mucosa anastomoses. Despite a series of prospective, randomized controlled trials, there continues to be a lack of consensus among surgeons as to which method provides the best outcome for patients.