Duct-to-mucosa pancreatojejunostomy for small main pancreatic duct by the parachute technique after pancreatoduodenectomy.

A duct-to-mucosa pancreatojejunostomy is technically difficult to perform for a small main pancreatic duct after pancreatoduodenectomy. Our group applied the parachute technique to reconstruct and attach a small pancreatic duct to the jejunal mucosa. This method makes it very easy to position stitches on the posterior row of the anastomosis. It also allows a complete view of every stitch, both inside and outside the pancreatic duct and jejunal wall. Sixteen patients underwent pancreatoduodenectomy followed by duct-to-mucosa pancreatojejunostomy by the parachute technique. Pancreatic fistulae developed in 3 of the patients, but none of the fistulae were severe. The median postoperative hospital stay was 14.5 days, and there were no postoperative deaths during that time. In conclusion, pancreatojejunostomy by the parachute technique is a simple method with a very low risk of pancreatic fistula formation and a considerably shortened postoperative hospital stay. The method is also useful for reconstruction with pancreatojejunostomy after pancreatoduodenectomy.