Surgery Today

, Volume 43, Issue 7, pp 821–824

End-to-side pancreaticojejunostomy without stitches in the pancreatic stump

  • Daisuke Hashimoto
  • Masahiko Hirota
  • Yasushi Yagi
  • Hideo Baba
How to Do It


In patients undergoing pancreaticoduodenectomy, leakage from the pancreatic anastomosis remains an important cause of morbidity and contributes to prolonged hospitalization and mortality. Recently, a new end-to-end pancreaticojejunostomy technique without the use of any stitches through the pancreatic texture or pancreatic duct has been developed. In this novel anastomosis technique, the pancreatic stump is first sunk into deeply and tightened with a purse string in the bowel serosa. We modified this method in an end-to-side manner to complete the insertion of the pancreatic stump into the jejunum, independent of the size of the pancreas or the jejunum. We tested this new anastomosis technique in four pilot patients and compared their outcomes with four control patients who underwent traditional pancreaticojejunostomy. No severe pancreatic fistulas were observed in either group. There were no differences in morbidity or hospital stay between the groups. This new method can be performed safely and is expected to minimize leakage from pancreaticojejunostomies.


Pancreaticoduodenectomy Pancreaticojejunostomy Pancreatic fistula 


  1. 1.
    Fernández-Cruz L, Belli A, Acosta M, Chavarria EJ, Adelsdorfer W, López-Boado MA, et al. Which is the best technique for pancreaticoenteric reconstruction after pancreaticoduodenectomy? A critical analysis. Surg Today. 2011;41:761–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Kawai M, Yamaue H. Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg Today. 2010;40:1011–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Hirota M. Percutaneous transfistulous interventions for intractable pancreatic fistula. Radiol Res Pract. 2011;2011:109259.PubMedGoogle Scholar
  4. 4.
    Hirota M, Kanemitsu K, Takamori H, Chikamoto A, Hayashi N, Horino K, et al. Percutaneous transfistulous pancreatic duct drainage and interventional pancreatojejunostomy as a treatment option for intractable pancreatic fistula. Am J Surg. 2008;196:280–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Hashimoto D, Takamori H, Sakamoto Y, Ikuta Y, Nakahara O, Furuhashi S, et al. Is an estimation of physiologic ability and surgical stress able to predict operative morbidity after pancreaticoduodenectomy? J Hepatobiliary Pancreat Sci. 2010;17:132–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Räty S, Sand J, Lantto E, Nordback I. Postoperative acute pancreatitis as a major determinant of postoperative delayed gastric emptying after pancreaticoduodenectomy. J Gastrointest Surg. 2006;10:1131–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Suzuki Y, Fujino Y, Tanioka Y, Hiraoka K, Takada M, Ajiki T et al. Selection of pancreaticojejunostomy techniques according to pancreatic texture and duct size. Arch Surg 2002;137:1044–7 (discussion 1).Google Scholar
  8. 8.
    Yang YM, Tian XD, Zhuang Y, Wang WM, Wan YL, Huang YT. Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol. 2005;11:2456–61.PubMedGoogle Scholar
  9. 9.
    Lämsä T, Jin HT, Nordback PH, Sand J, Luukkaala T, Nordback I. Pancreatic injury response is different depending on the method of resecting the parenchyma. J Surg Res. 2009;154:203–11.PubMedCrossRefGoogle Scholar
  10. 10.
    Nordback I, Lämsä T, Laukkarinen J, Leppiniemi J, Kellomäki M, Sand J. Pancreatico-jejunostomy with a biodegradable pancreatic stent and without stitches through the pancreas. Hepatogastroenterol. 2008;55:319–22.Google Scholar
  11. 11.
    Japan Pancreas Society. General rules for the study of pancreatic cancer, 6th edn. 2009.Google Scholar
  12. 12.
    Japanese society of biliary surgery. Society general rules for surgical and pathological studies on cancer of the biliary tract, 5th edn. 2003.Google Scholar
  13. 13.
    Hirota M, Kanemitsu K, Takamori H, Chikamoto A, Tanaka H, Sugita H, et al. Pancreatoduodenectomy using a no-touch isolation technique. Am J Surg. 2010;199:e65–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2012

Authors and Affiliations

  • Daisuke Hashimoto
    • 1
    • 2
  • Masahiko Hirota
    • 2
  • Yasushi Yagi
    • 2
  • Hideo Baba
    • 1
  1. 1.Department of Gastroenterological SurgeryKumamoto University Graduate School of Medical SciencesKumamotoJapan
  2. 2.Department of SurgeryKumamoto Regional Medical CenterKumamotoJapan

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