Inkwell pancreaticojejunal anastomosis after pancreaticoduodenectomy

Background End-to-end pancreaticojejunal anastomosis after Whippleʹs resection poses a difficult surgical challenge because the disparity in the relative sizes of the cut pancreas and the jejunum makes it difficult to ensure a water-tight seal. Leakage exposes patients to potentially serious postoperative complications and mortality. Methods We describe a new technique to provide accurate telescoping of the pancreas into the jejunum by dilating and inverting the jejunum over the friable pancreas. Results The method appears to prevent leakage of pancreatic fluid at the anastomotic site. It has been successfully performed in 5 cases. No patient showed any evidence of pancreatic leakage and all survived uneventfully. Conclusions The method is easy to perform and appears to be reliable. We believe it serves to reduce morbidity and mortality from pancreatic leakage.