Table 1 Structured program for teaching pancreatojejunostomy outside the operating room

General knowledge of pancreatojejunostomy

 Preoperative assessment of risk for development of a postoperative pancreatic fistula

 Various techniques for pancreatojejunostomy

 Postoperative complications

 Management of postoperative pancreatic fistula

Steps in the pancreatojejunostomy technique (modified Blumgart method)

 Preparation of the pancreas and the jejunum Preparation of the pancreas and the jejunum

 Marking the jejunal serosa

 Incision of the jejunal serosa

 Incision and puncture of jejunal wall at the site of duct-to-mucosa anastomosis

 Placement of an external stent

 U-shaped sutures on the posterior side of the jejunum and pancreatic parenchyma (three central sutures)

 U-shaped sutures on the jejunum and the pancreatic parenchyma (upper and lower edge sutures)

 Duct-to-mucosa anastomosis

 Suturing the anterior side of the jejunum (three central sutures)

 Suturing the anterior side of the jejunum (Upper and bottom edge)

 Ligation of U-shape sutures

 Placement of a drain