Horizontal hexagonal six-stitch pancreaticojejunostomy (HEXA-PJ): a simple and reproducible anastomotic technique

Pancreaticoduodenectomy (PD) is one of the most technically demanding gastrointestinal surgical procedures. Among its various components, pancreaticojejunostomy (PJ) is particularly complex. We developed a simple and easy-to-perform pancreaticojejunostomy technique, termed Horizontal Hexagonal Six-stitch Pancreaticojejunostomy (HEXA-PJ). After placing U-shaped sutures on the jejunal seromuscular layers and pancreas, the HEXA-PJ technique begins with the placement of two anterior traction sutures on the pancreatic duct, followed by suturing at the 3- and 9-o'clock positions. Owing to the improved visualization achieved through this sequence, the remaining posterior sutures can be easily placed. After completing the anterior sutures, the duct-to-mucosa anastomosis is finalized in a controlled manner. Finally, modified Blumgart sutures were placed and ligated. This structured approach can be easily learned and can shorten the anastomotic time of the PJ without increasing the risk of significant postoperative complications.