Saleh's Technique for Pancreaticojejunostomy (Pancreatic Parenchymal Injection of N-butyl-2-cyanoacrylate)

"This procedure is integrated into the standard pancreaticoduodenectomy.~Injection of Histoacryl® (n-butyl-2-cyanoacrylate) mixed with Lipiodol® (1:1 ratio) into the pancreatic parenchyma circumferentially (3, 6, 9, and 12 o'clock positions) around the main pancreatic duct (MPD) orifice, extending 5-8 mm deep and 5-10 mm laterally from the future anastomotic line, avoiding the main pancreatic duct and vessels. Total volume injected typically ranges from 0.2 ml to 0.6 ml.~Follow with standard duct-to-mucosa pancreaticojejunostomy:~* Tying down the posterior duct-to-mucosa sutures.~* Placing and tying the anterior duct-to-mucosa sutures.~* Tying down the posterior outer layer sutures.~* Placing the anterior outer layer sutures. Meticulously avoid glue contact with sutures/mucosa~Reconstruction: Complete the hepaticojejunostomy and duodenojejunostomy (or gastrojejunostomy)."