Pancreatic anastomosis after pancreaticoduodenectomy: how we do it

While mortality following pancreaticoduodenectomy has progressively decreased over the last decade, its morbidity, especially the development of pancreatic fistula, has remained constant over the years. However, high volume centers and individual surgeons report a major decrease in the rate of post-operative pancreatic fistulas. Technical refinements are crucial to reduce, and if possible prevent, the development of pancreatic fistula. No uniformity of opinion exists as to the method of pancreatic anastomosis after resection and few reports provide a detailed description of the actual technique employed. This article illustrates step-by-step the technique of pancreaticojejunostomy as practiced by the authors. Apart from presenting our previously published experience, results from other centres around the world are also provided in this review article.