Modified binding pancreaticogastrostomy vs modified Blumgart pancreaticojejunostomy after laparoscopic pancreaticoduodenectomy for pancreatic or periampullary tumors

Figure 1 Steps of modified binding pancreaticogastrostomy. A: Two full-thickness stay sutures are taken at the corners of the pancreatic cut surface; B: A posterior gastrotomy is made at a site where the pancreas can be invaginated without undue tension; C: Anterior gastrotomy of approximately 4-5 cm is made proximal to the stapled end of the stomach; D: A full-thickness purse-string suture is placed around the posterior gastrotomy using 2-0 polypropylene; E: The pancreas lifted using the stay sutures and invaginated into the stomach through posterior gastrotomy; F: At least 2 cm of the pancreas invaginated into the stomach. Purse-string suture tied to bind the gastric wall to the pancreatic stump.