Peustow Gillesby pancreatico-jejunostomy

ANATOMY
Five parts: Head, neck, body, tail and uncinate process
Blood supply lies posterior to ducts. Veins are superficial to arteries.

PROCEDURE
Enter lesser sac by dividing gastrocolic omentum
Kocherise duodenum (this makes palpation of stones easier).
The duct will be on the anterior surface of the duodenum
Free posterior wall of antrum from pancreas as far to right as possible to enable exposure of as much duct as possible (there may be a stone lying here)
Locate duct by needle aspiration
Incise duct over needle enough to insert right angle and diathermy along duct for 6-8cm ((be careful near the head or you’ll hit the pancreaticoduodenal arteries)
Spend time clearing the duct of calculi
Transect (GIA stapler) a loop of jejunum approx 30 cm from ligament of Treitz
Elevate transverse colon and incise an avascular area to permit distal jejunal limb to pass into lesser sac.
Perform side-side pancreaticojejunistomy with running 3-0 PDS (This is not a mucosa to mucosa anastomosis)
The jejunal side sutures can be full thickness but only take capsular bites on the pancreatic side to avoid blocking small ducts and having them leak
Suture jejunal loop to the edges of the opening of the transverse mesocolon
Create Roux en Y end to side jejunojejunostomy 45cm distal to pancreaticojejunostomy