Anastomotic technique, gastrointestinal, end-to-side, open, continuous hand suture, double layer

The anastomosis technique is demonstrated here by means of a duodenojejunostomy during a pylorus-preserving Whipple procedure. The distal duodenum has already been divided with a linear stapler.

First, skeletonize the duodenal wall in steps.

Due to the short gastric mesentery, the anastomosis cannot be rotated. Therefore, a so-called non-rotating technique is used here.
This comprises a double-layered suture technique (with PDS 4-0), with the posterior wall being anastomosed first.

Start with a seromuscular continuous suture. This apposes the posterior wall of the duodenum with the posterior wall of the jejunum.

Keep the suture ends as stay sutures for orientation in the next step.

Now resect the staple line at the proximal duodenum. Follow this by opening the jejunum accordingly along the antimesenteric aspect.

As the next step, place a full-thickness continuous suture on the inside of the posterior wall.