Pancreato-enteric anastomosis: the duct evagination technique

Pancreatic anastomotic failure remains the most frequent and potentially life-threatening complication following Pancreatoduodenectomy. Numerous modifications in the technique of the pancreatoenteric anastomosis have been reported. We suggest a simple modification which involves "evaginating" the cut end of the pancreatic duct. This technique helps avoid a compromise of the pancreatic ductal patency, and by achieving a wide pancreatic ductal opening can facilitate a safer pancreato-enteric anastomosis. In addition, by possibly decreasing the likelihood of post-operative pancreatic ductal stenosis, it has the potential to reduce post-Pancreatoduodenectomy pancreatic exocrine insufficiency. The modification acts as an adjunct to an already established technique yielding good results.