Tae Ho Hong, et al. with a short stent tube in order to avoid being sutured dur- ing anastomosing the pancreatic remnant to the stomach. Hemostasis on the cross-section of the pancreas was done by electrocautery or 4-0 monofilament suturing. Two stay sutures on both ends of the pancreatic stump are applied for traction of it into the gastric cavity (Fig. 1). The stomach is approximated to the pancreatic stump, and a longitudinal gastrotomy in the anterior gastric wall just above the presumed site of the PG in the posterior gas- tric wall is performed with an ultrasound scissors (Harmonic Scalpel UltraCision, Ethicon Endo-Surgery Inc., Cincinnati, OH, USA) (Fig. 2). Then, in accordance with the 3/4 diameter of the pancreatic stump, a transverse gastrotomy was made via electrocautery on the serosal surface of the posterior gastric wall (Fig. 3). At this point, care was taken to avoid extending the incision and making it too large and there was no need to incise deeply into the muscosa layer, which was easily punctured with a Kelly clamp and it adapted to the dimensions of the pancreas stump due to the great elasticity. Two stay sutures were brought anteriorly through the small hole in the mucosa layer of the posterior gastric wall. Applying slight traction on the sutures, the pancreatic stump was inserted into the gastric lumen and implanted approximately 2 cm. PG was completed with 2 transpancreatic sutures with buttresses on both the upper and lower edges of the im- planted pancreas through the retracted anterior gastro- tomy. Fig. 4 shows the performance of this suture, which needs two 4-0 monofilament polypropylene threads with a straightened needle at each end (4-0 Prolene, Ethicon Inc., Somerville, NJ, USA) and four buttresses (TFE Polymer Pledget, Ethicon Inc.). The suture first passed straightly from the proximal mucosal surface of the poste- rior gastrotomy and it passed the full-thickness of the pos- terior gastric wall, and then it penetrated from the dorsal surface to the ventral surface of the pancreas at a point 1.5 cm below from the cut end and it next passed the distal full-thickness of the posterior gastric wall. These simple sutures were performed at the both corners of the gastro- Fig. 5. The location of trocar placement and the mini-laparotomy in laparoscopy-assisted pancreatoduodenectomy at our institution. Fig. 4. Two transpancreatic sutures with buttresses on both the upper and lower edges of the implanted pancreas through the retracted anterior gastrotomy. Operative view (A) and schema (B) of this suture. 334 thesurgery.or.kr