Pancreaticojejunostomy by simple introduction after pancreaticoduodenectomy

The method which most surgeons still prefer in the treatment of the pancreatic stump after pancreaticoduodenectomy is pancreaticojejunostomy. In this article, we describe our preliminary experience with a fast, effective method, consisting in an end-to-end pancreaticojejunostomy by simple introduction, in 11 cases operated on without morbidity or mortality. From 1998 to 2002, 11 patients with pancreatic head or distal bile duct neoplasms underwent pancreaticoduodenectomy. After removal of the specimen, the residual pancreatic stump was prepared towards the left for about two centimetres, mobilizing the posterior surface from the porto-meseraic axis. A single layer of interrupted suture, consisting only in two posterior stitches, was enough in all cases; each stitch was done taking the stump full-thickness at about one centimetre from the transection margin (so as to introduce a corresponding portion of parenchyma into the jejunal lumen), and from the superior and inferior margin, respectively, of the pancreas. On the intestinal side, the stitches were passed full-thickness from the inner surface to the outside, 6 to 7 millimetres from the transection margin. After introducing the stump completely into the intestinal lumen, three anterior stitches were always done and knotted between the pancreatic capsule and the jejunum. All the anastomoses proved to be perfectly sealed.