Fish-mouth closure of the pancreatic stump and parachuting of the pancreatic end with double U trans-pancreatic sutures for pancreatico-jejunostomy

Abstract

Purpose: Leakage of pancreatico-jejunal anastomosis (PJ) remains the primary cause of morbidity and mortality after Whipple’s operation. To reduce the occurrence thereof, the present author recently began to apply a modification of the Blumgart method of anastomosis after Whipple’s operation (hereinafter referred to as Lee’s method), with very good results. Materials and Methods: The modified method and technique utilizes fish-mouth closure of a beveled pancreatic stump and parachuting of the pancreatic end with double U trans-pancreatic sutures (symmetric horizontal mattress-type sutures between the full thickness of the pancreas and the jejunal limb) after duct-to-mucosa pancreatico-jejunostomy. Results: Eleven cases of pylorus preserving Whipple’s operation have been performed without a clinically significant postoperative pancreatic fistula. Conclusion: This new method (Lee’s method) may dramatically reduce the occurrence of postoperative pancreatic fistula after Whipple’s operation.