title: How to do a safe pancreatic anastomosis.
abstract: OBJECTIVE
  Leakage of pancreaticojejunostomies has been associated with morbidity and mortality after pancreatic head resection. Different techniques have been described to perform a safe anastomosis to the left pancreatic remnant.
  
  
  METHODS
  The pancreaticojejunostomy is preferably performed as an end-to-side anastomosis; drainage of the pancreatic duct by catheters or stents is not performed at our institution.
  
  
  RESULTS
  Experience in more than 331 patients who underwent pancreaticojejunostomy indicates that a two-layer, single-stitch technique, with absorbable monofilament sutures and duct-to-mucosa adaptation, is a reliable method, with a pancreatic fistula rate of 2%.
  
  
  CONCLUSIONS
  The results obtained with the described technique of pancreaticojejunostomy indicate that the pancreatic anastomosis is very safe when performed by experienced hands and does not necessarily contribute to morbidity and mortality after pancreatic head resection. The prevalence of pancreatic fistulae and intraabdominal abscesses may further decrease, and the prevalence of nonpancreatic complications may have a more important impact on the outcome in the future.
authors.affiliation: Department of Visceral and Transplantation Surgery, University of Bern, Bern, Switzerland.
authors.forename: Kaspar
authors.initials: K
authors.lastname: Z'graggen
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D006801:Humans; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D013536:Suture Techniques