A standardized technique for safe pancreaticojejunostomy: Pair-Watch suturing technique

Figure 1 Preparation of pancreaticojejunostomy using pancreatic duct tube. A: A pancreatic duct tube is inserted as a stent tube into the main pancreatic duct of the pancreatic remnant from the cut-end; B: A very small part (usually 2-3 mm in diameter) of the jejunal serosa is cut by an electric cautery; C: The metallic needle of the pancreatic duct tube is introduced into the jejunum through the site of serosal cut and then taken out of the distal end of the jejunum (Roux-en-Y jejunal limb); D: The distance between the induced jejunal hole and the cut end of the main pancreatic duct should be kept 5 cm away or more, putting the pancreatic duct tube like a long loop during pancreaticojejunostomy.

Figure 2 A pattern diagram of first step of Pair-Watch suturing technique. After the seven sutures on the posterior wall have been finished, the following 5 stitches on the anterior wall of the pancreatic duct are usually placed in advance.

Figure 3 An intraoperative photograph of Pair-Watch suturing technique. A: All of twelve stitches are already put on between pancreatic duct and jejunal mucosa. B: Second layer anastomosis is finished.