STEP 15Gastric or duodenal reconstruction

The gastrojejunostomy is placed antecolic and is hand-sewn in two layers (A). When the pylorus is preserved, the duodenojejunostomy is created in an end-to-side fashion with a single layer, hand-sewn technique using monofilament absorbable sutures (B). The distance between the biliary and gastric/duodenal anastomoses is 50 cm to prevent reflux of gastric content.

A 10-Fr. feeding jejunostomy tube for postoperative enteral feeding is placed distal to the gastrojejunostomy using the Witzel technique.

The falciform ligament is placed between the CHA and the afferent jejunal limb to cover the stump of the GDA. This strategy may help to prevent pseudoaneurysm formation at the GDA stump in the event of a pancreatic anastomotic leak and resulting abscess formation.

Witzel Jejunostomy

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