Pancreatogastrostomy

Note: The video enters the operation of a partial duodenopancreatectomy after the completion of the resection phase.

Now the reconstruction phase begins with the pancreatic anastomosis. For this, stay sutures are first placed circularly on the pancreatic stump. To achieve the deepest possible invagination later, the pancreatic remnant is mobilized approximately 3-4 cm distally.

The operative site at the end of the resection phase presents with an exposed portal vein, which is formed by the confluence of the splenic vein and the superior mesenteric vein behind the pancreatic head.

After identifying a suitable site, a purse-string suture (PDS 2-0) is placed on the posterior gastric wall. Within the purse-string suture, the posterior gastric wall is then opened so that the opening is smaller than the diameter of the pancreas. It is essential to find the optimal ratio between pancreatic consistency, diameter, and gastrotomy opening. The implantation site should be chosen so that the remaining pancreas stands up through the implantation and hooks into the posterior gastric wall. The pancreatic body should be firmly embraced by the gastric serosa to achieve maximum tightness.