Pancreaticojejunostomy "dunk" technique

Two-layer bowel anastomosis-style PJ reconstruction with stent

 

00:09  SURGICAL TECHNIQUE

01:38  SEROSA POSTERIOR WALL

04:00  MUCOSA POSTERIOR WALL

06:18  MUCOSA ANTERIOR WALL

07:06  SEROSA ANTERIOR WALL

Technique description
  • The classic bowel anastomosis-style pancreaticojejunostomy, is also referred to as the "dunk" PJ.
  • To embed the pancreas cut surface into the small bowel, interrupted sutures are first placed in the pancreas, posterior to the cut surface, and then placed on the anti-mesenteric side of the bowel, perpendicular to the long axis.
  • An inner layer of sutures secure the pancreas cut surface to the small bowel mucosa, while a second outer layer folds bowel serosa over the pancreas cut edge, preventing pancreas capsule tearing and relieving tension on the inner mucosal anastomosis.
  • This technique is traditionally done without a stent, or any stitches placed in the duct, however in this case a stent was deemed necessary.
CTs scans (venous phase)

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