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Updated: Feb 15, 2026
02:20
Application of Mid-Pancreatectomy with End-to-End Anastomosis in Pancreatic Benign Tumors
Published on: February 9, 2024
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MODIFIED HEIDELBERG TECHNIQUE FOR PANCREATIC ANASTOMOSIS
Orlando Jorge M Torres1, Roberto C N da Cunha Costa1, Felipe F Macatrão Costa1
1Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luiz, MA, Brazil.
Summary
A modified Heidelberg technique for pancreatojejunostomy significantly reduces pancreatic fistula after pancreatoduodenectomy. This simple, reliable method shows promising early results in preventing major complications.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Pancreatic fistula is a significant complication following pancreatoduodenectomy, leading to increased morbidity and mortality.
- Various surgical techniques have been developed to mitigate this risk.
Purpose of the Study:
- To introduce a novel pancreatojejunostomy technique, a modification of the Heidelberg method, for reconstructing the pancreatic stump after pancreatoduodenectomy.
- To present the initial outcomes of this new technique.
Main Methods:
- The technique was applied to patients with varying pancreatic consistency and duct sizes.
- Suturing involved 5-0 double-needle Prolene for parenchymal stitches and 4-0 single-needle Prolene for continuous sutures.
- A plastic stent was placed in the pancreatic duct, and hemostatic sutures were used for stump closure.
Main Results:
- Seventeen patients underwent the procedure with no instances of Grade B or C pancreatic fistula.
- A biochemical leak, as per the International Study Group on Pancreatic Surgery definition, occurred in 23.5% of patients.
- No perioperative mortality was recorded.
Conclusions:
- The modified Heidelberg technique for pancreatojejunostomy is simple, reliable, and easy to learn.
- This technique demonstrates efficacy in reducing the incidence of pancreatic fistula after pancreatoduodenectomy.
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