What is the main goal of the 'jejunal scarf-covering method' and who is it for?

The primary goal of the 'jejunal scarf-covering method' is to prevent pancreatic fistulas (PFs) after pancreaticoduodenectomy (PD). This method is specifically designed for patients who have undergone a total gastrectomy, where traditional methods using the round ligament or greater omentum are not viable due to their resection during the prior surgery. This innovative technique utilizes the jejunum to protect the pancreaticojejunostomy (PJ) site.

How does the 'jejunal scarf-covering method' work in detail?

The 'jejunal scarf-covering method' involves several key steps. First, the second portion of the duodenum is resected. A pancreatic stent is inserted. Then the proximal jejunum is brought up to the hepatic hilum in a retrocolic position. A double jejunal loop is created. The remnant pancreas is placed on the loop, and a bilayer end-to-side anastomosis is constructed. The jejunal loop is then wrapped around the pancreaticojejunostomy site and secured to the pancreatic parenchyma. Finally, a hepaticojejunostomy is performed, and drains are placed to manage potential leakage.

Why is preventing pancreatic fistulas after pancreaticoduodenectomy so critical, and what are the implications if they occur?

Preventing pancreatic fistulas (PFs) after pancreaticoduodenectomy (PD) is critical because PFs are a major source of postoperative complications. These complications can include intra-abdominal abscesses, sepsis, hemorrhage, and a high risk of mortality. The 'jejunal scarf-covering method' aims to mitigate these risks by protecting the pancreaticojejunostomy site, reducing the chances of digestive fluids leaking from the pancreas, and thus, improving patient outcomes.

How does the 'jejunal scarf-covering method' differ from traditional approaches to prevent pancreatic fistulas?

Traditional approaches to prevent pancreatic fistulas (PFs) often involve wrapping the anastomotic site of the pancreaticoenterostomy using the round ligament, greater omentum, or both. However, these methods are not applicable in patients who have previously undergone a total gastrectomy, where these tissues are typically resected. The 'jejunal scarf-covering method' offers a novel solution by utilizing the jejunum to wrap the pancreaticojejunostomy site, providing a substitute for the unavailable tissues and thereby preventing pancreatic fistulas.

What are the benefits of the 'jejunal scarf-covering method' beyond simply preventing pancreatic fistulas?

Beyond preventing pancreatic fistulas (PFs), the 'jejunal scarf-covering method' contributes to maintaining postoperative nutrition for patients undergoing pancreaticoduodenectomy (PD). This is achieved by effectively protecting the pancreaticojejunostomy (PJ) site, which reduces the risk of complications and allows for a smoother recovery. By utilizing the jejunum as a substitute for unavailable tissues, surgeons can improve patient outcomes and minimize the disruptions to the patient's digestive process, allowing for a better chance of postoperative nutrition and overall recovery.

Illustration of the jejunal scarf-covering method, a surgical technique to protect the pancreas.

Scarf Technique: A Novel Way to Protect Pancreatic Surgery

Mira Elwood in Health & Wellness December 2025 • 5 min read.

"Discover how the 'Jejunal Scarf-Covering Method' can prevent life-threatening complications after complex abdominal surgeries."

Pancreaticoduodenectomy (PD) is a common surgical procedure for treating malignancies of the ampulla of Vater, duodenum, head of the pancreas, and distal common bile duct. Despite advances in surgical techniques and perioperative management that have led to lower mortality rates, the morbidity rate after PD remains high. One of the most serious postoperative complications is the pancreatic fistula (PF).

A pancreatic fistula occurs when digestive fluids leak from the pancreas after surgery, leading to intra-abdominal abscesses, sepsis, hemorrhage, and high mortality. To prevent PF, surgeons have explored various methods, including wrapping skeletonized vessels and the anastomotic site of the pancreaticoenterostomy using the round ligament, greater omentum, or both.

However, when patients have previously undergone a total gastrectomy, these traditional methods become unavailable because the round ligament and greater omentum are typically resected during the initial gastrectomy. To address this challenge, a novel technique has been developed: the 'jejunal scarf-covering method.' This innovative approach uses the jejunum to wrap the anastomotic site of the pancreaticojejunostomy, offering a new way to prevent pancreatic fistulas following PD in patients who have previously undergone total gastrectomy.

The Jejunal Scarf-Covering Method: A Step-by-Step Guide

Illustration of the jejunal scarf-covering method, a surgical technique to protect the pancreas.

The jejunal scarf-covering method involves several key steps to ensure effective protection of the pancreaticojejunostomy site. Here’s a detailed breakdown:

The procedure begins with the resection of the second portion of the duodenum, typically 20 cm proximal from the ligament of Treitz. This step includes the removal of the gallbladder and common bile duct, as well as the head of the pancreas. A pancreatic stent is then carefully inserted into and fixed within the pancreatic duct to provide additional support and drainage.

Retrocolic Positioning: The proximal jejunum is brought up to the hepatic hilum in a retrocolic position.
Jejunal Loop Creation: A 15 cm segment of the proximal jejunum is bent downward. The serosa of the jejunum is sutured side-to-side for 5-6 cm using 3-0 silk to create a double jejunal loop.
Pancreas Placement: The remnant pancreas, along with the pancreatic duct tube, is placed on the jejunal double loop.
Anastomosis: A bilayer end-to-side anastomosis is constructed using duct-to-mucosa anastomosis with interrupted 4-0 absorbable sutures. This is reinforced by a seromuscular-parenchymal layer of 3-0 silk on one side of the jejunum on the jejunal double loop.
Stent Exit: The pancreatic duct tube is brought out through the jejunum and the abdominal wall.
Jejunal Wrapping: The proximal site of the jejunal loop, opposite the PJ, is bent over, rolled around, and carefully wrapped around the anastomosis of the PJ.
Securing the Wrap: The serosa of the jejunum surrounding the area is sutured to the pancreatic parenchyma using 3-0 silk to ensure a secure and stable covering.
Final Reconstruction: An end-to-side hepaticojejunostomy is performed using a single layer of interrupted 4-0 absorbable monofilament sutures, and a biliary lost tube is inserted.

Finally, two drains are placed—one for the hepaticojejunostomy and another for the PJ—and brought out on the right side just below the subcostal incision to manage any potential leakage.

Why the Jejunal Scarf-Covering Method Matters

The jejunal scarf-covering method represents a significant advancement in surgical techniques aimed at preventing pancreatic fistulas following pancreaticoduodenectomy, especially in patients who have previously undergone total gastrectomy. By utilizing the jejunum as a substitute for the round ligament or greater omentum, which are often unavailable in these complex cases, surgeons can effectively protect the anastomotic site and reduce the risk of postoperative complications. This innovative approach not only improves patient outcomes but also contributes to maintaining postoperative nutrition, making it a valuable addition to the field of gastroenterological surgery.