Anastomotic technique, gastrointestinal, end-to-side, open, continuous hand suture, double layer - general and visceral surgery

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  • Preparing the intestinal wall

    The anastomosis technique is demonstrated here by means of a duodenojejunostomy during a pylorus-preserving Whipple procedure. The distal duodenum has already been divided with a linear stapler.

    First, skeletonize the duodenal wall in steps.

  • Intestinal suture step 1A - double-layered suture - posterior wall

    Due to the short gastric mesentery, the anastomosis cannot be rotated. Therefore, a so-called non-rotating technique is used here.
    This comprises a double-layered suture technique (with PDS 4-0), with the posterior wall being anastomosed first.

    Start with a seromuscular continuous suture. This apposes the posterior wall of the duodenum with the posterior wall of the jejunum.

    Keep the suture ends as stay sutures for orientation in the next step.

  • Intestinal suture step 1B - double-layered suture - posterior wall

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    Now resect the staple line at the proximal duodenum. Follow this by opening the jejunum accordingly along the antimesenteric aspect.

    As the next step, place a full-thickness continuous suture on the inside of the posterior wall.

  • Intestinal suture step 2A - double-layered suture - anterior wall

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  • Intestinal suture step 2B - double-layered suture - anterior wall

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  • Inspecting the anastomosis

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date of update: 11.06.2019
date of publication: 20.05.2012

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