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Pancreaticojejunostomy—a review of modern techniques
This briefing document synthesizes key insights from a review of modern pancreaticojejunostomy (PJ) techniques, focusing on their procedural methodologies and their impact on postoperative outcomes, specifically the prevention of pancreatic fistulas. Executive Summary The anastomosis of the pancreatic stump remains the most challenging phase of pancreaticoduodenectomy (PD). Technical failure at this stage frequently leads to postoperative pancreatic fistula (POPF), a complication with mortality rates as high as 26% in severe cases. While alternative methods such as duct ligation or total pancreatectomy exist, pancreaticojejunostomy (PJ) remains the preferred method for preserving endocrine and exocrine functions. Current surgical literature indicates that no single PJ technique has been proven universally superior in eliminating the risk of POPF . Instead, the selection of a technique must be individualized, considering patient-specific risk factors —such as a "soft" panc...
History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique
Executive Summary The history of pancreatic surgery, particularly the reconstruction following pancreaticoduodenectomy (PD), is defined by a persistent struggle against postoperative complications, most notably anastomotic failure. While pioneers in the late 19th and early 20th centuries initially avoided pancreaticoenteric anastomosis, by the 1940s, the procedure became recognized as indispensable for preventing fatal leaks of pancreatic juice. Current surgical practice generally employs two methods : invaginating end-to-end or end-to-side anastomosis . However, both techniques carry risks of ischemia, necrosis, or the creation of "dead spaces" that lead to pancreatitis. A refined surgical technique, developed and utilized in clinical practice since 1990, emphasizes a "less is more" approach . By utilizing a limited number of interrupted sutures (six to eight) and ensuring the jejunal wall completely covers the pancreatic cut surface without excessive tension, ...
Circumportal pancreas: a review of the literature and image findings
Executive Summary Circumportal pancreas (CP) is a rare congenital anomaly characterized by the encasement of the portal vein (PV) and/or superior mesenteric vein (SMV) by fused pancreatic tissue. While commonly found in swine, it is present in only 1–3.4% of the human population and is typically asymptomatic, often discovered incidentally during abdominal imaging. The primary clinical significance of CP lies in its impact on pancreatic surgery . Preoperative identification is critical to avoid major complications, most notably pancreatic fistulas , which occur in approximately 38.5% of reported surgical cases. CP is also frequently associated with vascular variants , such as replaced hepatic arteries , which can complicate oncologic resections and vascular reconstructions. Advanced imaging (CT and MRI) is the gold standard for diagnosis, allowing surgeons to classify the anomaly based on the l ocation of the pancreatic duct and the site of fusion relative to the splenic vein....