A simple and safe anastomosis in pancreaticogastrostomy using mattress sutures

When a suture does not trap a sufficient volume of pancreatic parenchyma in the conventional pancreatic anastomosis, laceration may be caused by even modest tension. Therefore, we used mattress sutures with gastric wall, which works protectively. An opening was made on the posterior wall of the stomach. By using a 3-0 polypropylene monofilament thread with a straightened needle at each end, the proximal gastric wall, the pancreas, and the distal gastric wall were sutured sequentially to accomplish anastomosis in a U-like fashion. After 2 to 4 additional sutures were completed, the pancreatic stump was invaginated into the stomach and all sutures are tied. Mattress sutures were made on the pancreas, which was held between the superior and inferior walls of the stomach. Postoperative amylase levels in the drainage fluid decreased significantly and none of the 17 patients developed pancreatic fistula formation. The technique is simple and shortens the time required for anastomosis.