Technical Details of a Modified End-to-Side Invagination Technique of Pancreatojejunostomy

Luca Morelli, MD, FACS; Niccolò Furbetta, MD; Gregorio Di Franco, MD; Simone Guadagni, MD; Matteo Palmeri, MD; Desirée Gianardi, MD; Matteo Bianchini, MD; Manuel Bordonaro, MD; Franco Mosca, MD, FACS; Giulio Di Candio, MD

Product Details
Product ID: ACS-5634
Year Produced: 2018
Length: 10 min.


The treatment of pancreatic stump is a critical step of pancreaticoduodenectomy (PD) because leaks from this anastomosis incur major morbidity and mortality. We describe the technical details of a modified end-to-side, invagination pancreatojejunostomy (mPJ). Methods: This technique consists of a particular double layer of stiches: the outer layer is a monofilament not absorbable interrupted U-stiches (using 5-0 polypropylene suture) to reach the invagination of the pancreatic stump and with the knot falling on the bowel; a small enterotomy is made in the jejunum exactly opposite respect to the location of the pancreatic duct, and a stent is inserted inside the duct. The internal layer is a row of continuous running suture, placed between the pancreatic capsule/parenchima and the sieromuscular layer of the jejunum. Results: The mPJ technique combines the advantages of the previous techniques and could mitigate their weaknesses: the small incision of the jejunal wall together with the running suture for the inner layer that creates a waterproof suture line, allows to drain into the jejunum the pancreatic juice from the secondary duct; the outer layer, thanks to the knots tied on the jejunum, protect the first layer and minimise the risk of pancreatic capsule laceration. Conclusions: The mPJ technique is safe and reproducible. In our experience, it is associated with a lower pancreatic fistula rate than expected especially for the pancreas with soft gland texture and small pancreatic duct diameter.