Pancreaticojejunostomy with invagination of spatulated pancreatic stump into a jejunal pouch.
BACKGROUND
Pancreaticoenteric anastomosis after pancreatic resection is of major concern as anastomotic leak continues to be common. There is no unanimity for the preferred technique and overall incidence of pancreatic leak is reported to be 2% to 14%.


METHODS
A new safe method of anastomosing pancreatic stump to a jejunal pouch is described. A 15-cm length of the jejunal end is detubularized and reconfigurated into a U-shaped patch. The pancreatic stump is mobilized for about 3 cm and the duct is spatulated posteriorly and anastomosed to a cut in convex margins of the patch. This is converted into a pouch invaginating the spatulated pancreaticojejunal anastomosis.


RESULTS
Eleven cases of periampullary malignancy after pancreaticoduodenectomy have been operated on with no pancreatic leak.


CONCLUSIONS
Even a bulky pancreas can be invaginated into the pouch. The resulting anastomosis is completely intraluminal. Spatulated mucosa to mucosa anastomosis should reduce the chances of late stenosis.
Asopa
Hari S
HS
Department of Surgery, Asopa Hospital and Research Centre, Agra, UP, India. drhasopa@sancharnet.in
Garg
Mukul
M
Singhal
Govind G
GG
Singh
Lakhan
L
Asopa
Jyoti
J
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000379:methods*; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D015282:Octreotide