Pancreatoduodenectomy with a novel pancreato-jejunal anastomosis by the single-layer long parenchymal traverse technique (Siriwardena technique): Early demonstration of safety in practice development in Sri Lanka.

Introduction
Pancreatoduodenectomy (PD) is the standard of care for localized tumours of the head of the pancreas.  The anastomosis between the remnant pancreas and the intestine is a high-risk anastomosis.
This study reports on the outcome of a new technique for an end to side, duct to mucosa pancreaticojejunostomy.

Patients and methods
Conventional pancreaticoduodenectomy was performed by an individual surgeon between the period of 2013-2014 and 2017- 2019 on 26 patients were included for the study. The postoperative pancreatic fistula (POPF) rate was observed with pancreatic leakage grouped according to 2016 ISGPS guidelines.

Results
There were 26 patients, 9 women and 17 men who underwent pancreatoduodenectomy with pancreato-enteric anastomosis by this new method. The mean age of the patients ranged from 56.7 to 56.8 years. Adenocarcinoma of the ampulla was the most frequent indication (n=10). Post-operatively, 9 (35%) had POPF and one (4%) required a re-exploration. POPF Type A was common (n=8) and did not require any interventions, where Type C was observed in 1 (4%). The consistency of the gland or the duct size did not show any significant difference with the fistula rate.

Conclusion
The new single layer interrupted pancreatojejunal anasto-mosis with a long parenchymal traverse technique is safe  with acceptable outcomes.