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Background: Pancreatic anastomotic leakаgе is one of the most serious complications following pancreaticoduodenectomy (PD). The most significant risk factors for pancreatic leakage are pan- creatic texture, main pancreatic duct (MPD) size and anastomotic technique. Herewith we des- cribe our technical modifications for single-layer pancreaticojejunostomy (PJ) with a soft pancreas and nondilated MPD for reconstruction after PD. Methods: We report our early experience using this technique in 52 patients who underwent PD between May 2009 and December 2012. Results: Overall postoperative mortality rate was 1.92%. Postoperative morbidity rate was 32.69%, with major complications occurring in three patients (5.77%). Pancreatic leak was diagnosed in six patients (11.54%). Three patients with pancreatic fistulae (PF) of Grades A and B were managed conservatively, whereas three other patients with PF of Grade C required relaparotomy. Con- clusions: According to our early experience with this modified technique for PJ, usage of hori- zontal mattress sutures, "everting" of MPD and incorporation of its wall into a single layer pan- creatic-enteric anastomosis result in a low pancreatic anastomotic leakage rate after PD. This technique for PJ with a soft pancreas and nondilated duct ensures ideal preconditions for anasto- mosis healing. They consist of an excellent blood supply, an anatomical position with tension-free approximation and unobstructed pancreatic juice flow from the pancreas into the jejunal loop.

A Simple and Dependable Technique for Pancreatic-Enteric Anastomosis with a Soft Pancreas and Nondilated Duct