STEP 13Pancreatic reconstruction

The pancreatic remnant is mobilized from the retroperitoneum and splenic vein for a distance of 2-3 cm to allow suture placement for the pancreaticojejunal anastomosis.

We bring the transected jejunum retrocolic through a generous defect in the transverse mesocolon to the left of the middle colic vessels.

We prefer a two-layer, end-to-side pancreaticojejunostomy with a small stent when the pancreatic duct is not dilated. The outer row consists of interrupted 4-0 seromuscular monofilament sutures. The inner row consists of 4-0 or 5-0 interrupted monofilament sutures approximating full-thickness pancreatic duct to full-thickness jejunum. Posterior knots are tied on the inside, while the lateral and anterior knots are tied on the outside. If a stent is used, prior to securing the anterior sutures, the stent is placed across the anastomosis so that it extends into the pancreatic duct and small bowel for a distance of approximately 2 cm, respectively.

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