JEJUNAL EVERSION MUCOSECTOMY AND INVAGINATION: AN INNOVATIVE TECHNIQUE FOR THE END TO END PANCREATICOJEJUNOSTOMY

Background: The pancreatojejunostomy has notoriously been known to carry a high rate of operative complications, morbidity and mortality, mainly due to anastomotic leak and ensuing septic complications.
Objective: In order to decrease anastomotic leak and its attendant morbidity and mortality in operations requiring a pancreato-jejunal anastomosis, and also in order to simplify the operation, a new technique was developed by the author and subsequently termed "JEMI", i.e., Jejunal Eversion Mucosectomy and Invagination.
Method: This method consists of preparation of a Roux-en-Y jejunal limb, eversion of the limb end to expose the jejunal mucosa, submucosal saline injection, and mucosectomy of a 2 cm cuff of mucosa saving the submucosal vessels and a seromuscular cuff of jejunum. The pancreatic remnant is next prepared to accept the prepared limb by freeing 2 cm of pancreatic tissue. This is followed by suturing the edge of the mucosa to the edge of the pancreatic capsule via 3/0 vicryl or PDS, pulling the mucosectomized cuff over the pancreatic remnant, and suturing the edge of the seromuscular cuff onto the pancreatic capsule via 3/0 vicryl or silk.
Result: 18 patients underwent a pancreatojejunal anastomosis after pancreatic resection during a 4 year period by the author. No case of pancreatic fistula or leak was observed in any of the cases, and all cases were discharged from the hospital on PO day 6, except for one patient who was discharged on PO day 12 due to delayed gastric emptying, and one early post operative death due to extensive myocardial infarction.
Conclusion: This technique appears promising and is gaining popularity in our institution, and is therefore recommended as a choice method for any operation requiring a pancreatojejunal anastomosis.