To study a safe, reliable, simpler and commonly used pancreaticojejunal anastomotic method called penetrating-suture pancreaticojejunostomy (PPJ) completely different from any other existing methods in pancreaticoduodenectomy(PD).

From May 2002 to June 2012, a new surgical technique, anastomosis of the pancreas stump and jejunal wall with penetrating-suture technique was performed upon 47 patients in pancreaticoduodenectomy. This new method was based on the new concept that the pancreas stump should be anastomosed to the jejunum in a way as a parenchymatous organ rather than a tubular organ. The full-thickness of the pancreas stump was incorporated with posterior and anterior walls of the jejunum by placing a single needle suture. The entire anastomosis requires only 6-8 sutures. A short stent tube inserted into the pancreatic duct and fixed with a suturing thread was placed through the anastomosis into the jejunum before knot-tying. All layers of the jejunum wall on the corresponding site was cut in the end to side PPJ. The clinical data were reviewed and analyzed.

The median time to perform PPJ was 12 min(ranging from 8 to18 min). The rate of Postoperative Pancreatic Fistula (measured using International Study Group of Pancreatic Fistula definition) was 29.8%(14/47) in all, including grade A 21.3%(10/47), grade B 8.5%(4/47). There was no pancreatic anastomotic leakage and bleeding. There was no reoperation, or mortality among patients in this series. Pancreatic duct patency was confirmed by CT and MRI in 34 patients 3 months after surgery.

The PPJ procedure is effective in avoiding anastomotic leakage and is applicable to all patients in whom the pancreatic duct can be identified.