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Pylorus-preserving Pancreaticoduodenectomy (PPPD) with Technical Modifications
Yi Miao*
Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Our PPPD started with Kocher maneuver. After dissection of gastrocolic ligament, pancreas was explored. Duodenum was divided 5mm distal to the pylorus. Common hepatic duct was transected and right aspect of hepatoduodenal ligament was cleared. GDA was ligated and divided. Neck of the pancreas was divided by electrocautery. Hemostasis of the pancreatic stump was achieved by sutures. Reconstruction included a modified one-layer duct-to-mucosa pancreatojejunostomy, one-layer hepatojejunostomy and one-layer duodenojejunostomy. All sutures should meet the following features: substantial bite, sparse suture and loose knot. Afferent loop decompression was also utilized to lower the risk of fistula.


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