ABSTRACT
One of the most important operative steps to prevent severe postoperative complications is the pancreaticojejunostomy. We prefer to perform this anastomosis end-to-side in a twolayer fashion stitching the pancreatic duct separately ( Fig. 8.3 ). Using this technique, insufficiency rates of less than 3.5% can be achieved ( 9 , 10 ). Bile duct reconstruction should be standardized as well to avoid leakage or postoperative bile collections. Although this complication is less frequent than pancreatic fistula, it may cause severe and long-lasting complications. An approach that can be performed even in technically challenging situations with small and deep ducts is the single-stitch distant suture of the posterior wall by a one-layer technique completed by single stitches of the anterior wall. Finally, an end-to-side duodenojejunostomy completes the reconstruction. Recent studies have shown that an antecolic reconstruction is much more favorable in terms of delayed gastric emptying ( 1 , 12 ).
