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An Alternative Pancreatic Anastomosis Following Pancreaticoduodenectomy

Georgia Bitsakou, MD; Adam E. Frampton, MRCS; Madhava Pai, MSc, FRCS; Long R. Jiao, MD, FRCS
Arch Surg. 2011;146(6):752-754. doi:10.1001/archsurg.2011.133.
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Pancreatic head resection and reconstruction is technically challenging. Eight patients underwent pancreaticoduodenectomy for either ductal adenocarcinoma (n = 7) or neuroendocrine tumor (n = 1) in the head of the pancreas with a dilated pancreatic duct. The pancreatic stump could not be mobilized to form a standard pancreaticogastrostomy or a pancreaticojejunostomy following resection because of a complete fixation to the splenic vein (n = 2), common hepatic artery (n = 1), or mesentery (n = 3) or inadequate length of the pancreatic remnant (n = 2). After laying open the pancreatic duct along the pancreatic transection margin in the ventral aspect of the pancreas, a longitudinal ventral pancreaticojejunostomy was performed using polydioxanone 3/0 sutures. The average time taken to create this pancreatic anastomosis was less than 10 minutes. This longitudinal ventral pancreatic anastomosis is quick, easy to perform, and a safe alternative method for pancreatic reconstruction after pancreaticoduodenectomy.

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This diagram shows the pancreatic reconstruction with the longitudinal ventral pancreatic anastomosis following a pylorus-preserving pancreaticoduodenectomy.

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