A novel reconstructive procedure after pancreaticoduodenectomy: J-pouch dunking pancreaticojejunostomy.

Leakage of the pancreaticojejunostomy remains a major complication after pancreaticoduodenectomy. Several methods have been advocated in order to reduce anastomotic fistula but none of them reached a significant difference in preventing the leakage. We developed a new technique called J-pouch dunking pancreaticojejunostomy. A J pouch is made from the distal 20 to 30cm of jejunum by using a GIA linear stapler. A transverse incision is made on the jejunal base. As a result, we a have enough jejual stems in anastomose the pancreatic remnant. A soft pancreas and small pancreatic size are known to be risk factors in pancreatic anastomosis. This technique is designed to eliminate the several factors relnted to pancreatic anastomotic leakage.