Exocrine drainage of the pancreas graft remains a major unsolved problem. The jejunum 40-50cm distal to the ligament of Treitz is selected for a side-to-side duodenojejunostomy. With portomesenteric venous drainage, the entire graft is intraperitoneal. The anastomosis should be about 30-50mm in length. The anastomosis is performed in two layers with the inner layer as a running 4-0 absorbable suture, including all layers of the gut wall. The outer layer is performed with interrupted 0 silk seromuscular sutures.
Second layer of the duodenal anastomosis: Once the running suture is achieved, the second layer of interrupted stitches of silk is performed. As an alternative, the second layer may be a running suture.
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