Yijun Chen, MB, Xuefeng Zhu, MM, Jianjun Huang, MB, Youngsheng Zhu, MB

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End-to-Side Penetrating-Suture Pancreaticojejunostomy: A Novel Anastomosis Technique Yijun Chen, MB, Xuefeng Zhu, MM, Jianjun Huang, MB, Youngsheng Zhu, MB Journal of the American College of Surgeons Volume 221, Issue 5, Pages e81-e86 (November 2015) DOI: 10.1016/j.jamcollsurg.2015.08.010 Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 1 The jejunostomy was made with a full-thickness incision. The length of the jejunostomy was approximately 2 cm (1 cm less than the transverse diameter of the pancreatic transecting surface). A matching stent was inserted into the main pancreatic duct and secured with sutures at the opening of the pancreatic duct. Journal of the American College of Surgeons 2015 221, e81-e86DOI: (10.1016/j.jamcollsurg.2015.08.010) Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 2 Using nonabsorbable interrupted suture, each suture completely penetrates the pancreatic parenchyma from anterior to posterior, then from posterior to anterior, traversing the full thickness of the jejunal posterior wall, and then the anterior wall. For the jejunal wall sutures, the first and the last sutures should be placed at the upper and lower edges of the jejunostomy on the outer side. Journal of the American College of Surgeons 2015 221, e81-e86DOI: (10.1016/j.jamcollsurg.2015.08.010) Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 3 Anterior view of the pancreaticojejunal anastomosis after sutures are knotted. Journal of the American College of Surgeons 2015 221, e81-e86DOI: (10.1016/j.jamcollsurg.2015.08.010) Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 4 Schema of longitudinal section through the pancreatic duct shows that the intestinal wall was adhered to the cut surface of the pancreas and the cut edge of the jejunum connected with the opening of the pancreatic duct around the stent tube after all sutures were knotted. Journal of the American College of Surgeons 2015 221, e81-e86DOI: (10.1016/j.jamcollsurg.2015.08.010) Copyright © 2015 American College of Surgeons Terms and Conditions