■ It may be difficult to palpate the duct, and various maneuvers may help.
■ Kocherize the duodenum and palpate carefully the head of the pancreas.
■ Perform intraoperative ultrasonography.
■ Choose an area in the mid body of the pancreas and perform a vertical incision in hope of bisecting the duct.
■ Once some incision has been made in the parenchyma, the surgeon may safely massage the tail and proximal body of the pancreas in hope of expressing pancreatic juice.
■ Avoid trying to access the pancreatic duct directly over the superior mesenteric vein/portal vein/splenic vein junction - too deep an incision may lead to serious bleeding.
■ Concentrate on getting a good size match between the ductal incision and the jejunal incision; mismatches in size can lead to pancreatic leak.
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