Pancreatogastrostomy

Note: The video joins the partial duodenopancreatectomy after completion of the resection phase.

The reconstruction phase now starts with the pancreatic anastomosis. For this purpose, first place stay sutures in circular fashion on the pancreatic remnant. For the deepest telescope-type invagination of the pancreatic remnant possible, mobilize the latter some 3-4 cm distad.

At the end of the resection phase, the portal vein arising from the confluence of the splenic vein and the superior mesenteric vein posterior to the pancreatic head is exposed.

After checking for an appropriate location, place a purse-string suture (PDS 2-0) on the posterior gastric wall. Divide the posterior wall of the stomach within the purse-string suture such that the opening is smaller than the diameter of the pancreas. The trick is to best balance pancreas consistency, diameter and gastrotomy opening. Select the site of implantation such that the implantation will make the pancreatic remnant stand up and "hook" into the posterior gastric wall, as it were. The best seal possible is achieved when the pancreatic body is tightly enclosed by the gastric serosa.

Next, perform a limited gastrotomy on the opposite anterior gastric wall between stay sutures.