Tips for Avoiding Wirsung Stump Loss after Enlargement of Pancreatic Resection Margin during Laparoscopic Pancreaticoduodenectomy

Damiano Caputo, MD, FACS; Chiara Cascone, MD; Mariacristina Cartillone, MD; Vincenzo La Vaccara, MD, PhD; Lorenza Caggiati, MD; Tommaso Farolfi, MD; Alessandro Coppola, MD, PhD; Roberto Coppola, MD, FACS

Product Details
Product ID: ACS-5859
Year Produced: 2019
Length: 5 min.


In this case, following the creation of the retropancreatic tunnel, the pancreas was divided and pancreatic duct identified. Frozen section examination of pancreatic margin showed residual tumor and extension of the resection to the body of the gland was needed. After the resection, the Wirsung duct was no longer detectable and instead of an end-to-side duct-to-mucosa pancreatojejunostomy, an end-to-side pancreatojejunostomy was necessarily performed. 2-0 silk interrupted stitches were placed through the posterior pancreatic wall and the jejunum. A large enterotomy was needed to drain the whole pancreatic stump and the anterior layer of pancreatojejunostomy completed with interrupted 2-0 silk sutures. Even though the role of internal stent in preventing pancreatic fistula is still debated, based on this experience, it is our opinion that intraoperatively stenting of small pancreatic duct can be helpful when the extension of resection is needed. The stent allows keeping the duct detectable, avoid its loss where the size becomes smaller and protect accidental duct closure when stitches are placed through the gland and the jejunum.