Annals of Hepato-Biliary-Pancreatic Surgery

Indexed in /covered by CAS, KoreaScience & DOI/Crossref:eISSN 2508-5859   pISSN 2508-5778

Fig. 1.

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Fig. 1. Diagrammatic representation of the surgical technique. (A) Shows preparation of pancreatic stump. Approximately 2–3 cm of the body of the pancreas is cleared off soft tissue and veins draining to splenic veins are tied. (B) (Anterior first layer). Passing of the first layer of sutures from the anterior serosal surface of the pancreas through the cut surface of the pancreas. These are numbered and held aligned by hemostats. (C) (Anterior second layer). Passing of the second layer of sutures from the cut surface of the pancreas through the anterior wall of the pancreatic duct. These are numbered and held aligned by hemostats. (D) (Posterior second layer) passing of posterior second layer of sutures from the posterior wall of the duct through the cut surface of the pancreas. These are numbered and held aligned by hemostats. (E) (Posterior first layer) Passing of posterior first layer of sutures from the cut surface of the pancreas through the posterior serosal surface of the pancreas. These are numbered and held aligned by hemostats. (F) The greater curvature of the stomach is flipped anteriorly and superiorly. Appropriate site of approximation of the pancreas to the posterior surface of the stomach is identified and posterior first layer sutures are passed through the posterior layer of the stomach in the sero-muscular plane and tied. This completes the posterior first layer. (G) A small gastrotomy of the size of the duct is made in the posterior wall of the stomach. Sutures of the posterior second layer are now passed from the serosal surface of the stomach full thickness into the lumen and taken out from the lumen of the gastrotomy site and tied. This completes the posterior second layer. (H) Sutures of anterior second layers are now passed through the gastrotomy from the mucosal surface of the stomach full thickness and taken out from the serosal side and tied. This completes the anterior second layer. (I) Demonstrates the completed duct to mucosa anastomosis and now the sutures from the anterior first layer are passed in the sero-muscular plane of the stomach and tied. This completes the anterior first layer. (J) Shows the completed anastomosis where the only duct to mucosa anastomosis is visible in the posterior wall of the stomach.
Ann Hepatobiliary Pancreat Surg 2021;25:251-8 https://doi.org/10.14701/ahbps.2021.25.2.251
© 2021 Ann Hepatobiliary Pancreat Surg