Re: Technique of lateral pancreaticojejunostomy.

Accessible online at: http://BioMedNet.com/karger Dear Sir, I read with interest the beautifully written ‘How I Do It’ article by Dr. Richard Prinz entitled ‘Technique of Lateral Pancreaticojejunostomy’ in the June 1997 issue. While I agree with most all of his technical points, I notice in figure 3 that the Roux limb is brought through the right transverse mesocolon and oriented with the blind end towards the patient’s left (tail of pancreas). I orient my Roux limb differently, bringing it through the left mesocolon with the blind end of the Roux limb towards the head of the gland. While this is neither technically easier nor technically more difficult than the technique outlined by Dr. Prinz, it makes any type of reoperative surgery that might be necessary on the pancreas much easier. Usually when further surgery is needed in patients after a pancreaticojejunostomy, it is to remove or deal with the head of the pancreas. If the Roux limb is oriented as described by Dr. Prinz, the mesentery of the Roux limb will cover the superior mesenteric vessels, making it difficult to gain appropriate and safe exposure of the pancreas. If the Roux limb is oriented as I have described, exposure of the superior mesenteric vein is much easier. Michael G. Sarr, MD Professor of Surgery, Mayo Medical School Chair, Division of Gastroenterologic and General Surgery Mayo Clinic and Mayo Foundation Rochester, MN 55905 (USA)