Although the operative mortality of pancreaticoduodenal resection has decreased recently, the operative morbidity resulting from a leaking pancreatic anastomosis remains high. We described our experience in 50 consecutive cases with a simple, secure end to side pancreaticojejunostomy. We used a paediatric nasogastric tube in the pancreatic remnant duct as a temporary external pancreatic drain. There were 29 men and 21 women ranging from 12 to 84 years with a median age of 61 years. Forty-two patients underwent a standard Whipple procedure and eight a pylorus preserving pancreaticoduodenectomy. Average operating time was 270 minutes with a range of 170 to 480 minutes. The pancreaticojejunostomy could be constructed in a mean of 8 minutes. Intraoperative blood loss ranged from 150 to 3500 mL with a mean of 910mL. Twenty-five patients (50 %) received no blood transfusion. The consistency of the pancreatic remnant was hard in 12 patients (24 %) and normal in 38 patients (76 % mortality [7,8,23] the pacreatic duct, and secured with a suture of 3-0 chromic catgut. The nasogastric tube was pulled through the jejunum via a stab wound in both sides of the jejunum, which was 10 to 15 cm distal to the hepaticojejunostomy, and was brought out extraabdominally. A row of 3-0 silk sutures were placed through the posterior pancreatic parenchyma, the pancreatic capsule and the posterior seromuscular layer of the jejunum. Then, these sutures were tied to approximate the pancreatic remnant and the jejunum posteriorly. (Fig. 1) The anastomosis was completed with several interrupted 3-0 silk sutures between the anterior
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