Preventing pancreatic fistula after distal pancreatectomy: An invagination method

Figure 1 The low density tumor in the pancreatic tail (white arrow).

Figure 2 Fluorodeoxyglucose-positron emission tomography scan showing the swollen part in the pancreas tail and umbilical region (white arrow) with abnormal accumulation.

Figure 3 Our procedure. A: We invaginate the pancreatic stump into the posterior wall of the stomach with single layer anastomosis using a 3-0 absorbable suture; B: The pancreatic tail tumor is indicated by the index finger on the left-hand side; C: Measurement of the width of the stump; D: The cutting length is determined at about 80% of the stump width; E: Anastomosis is completed. The pancreatic stump is invaginated into the posterior wall of the stomach.

Figure 4 The change of the invaginated pancreatic stump in the stomach. A: The invaginated pancreatic stump in the stomach after 1 wk; B: The stump after 3 mo; C: The stump after 1 year.