HOW I DO IT A Penrose Drain to Help Reflect the Resected “Specimen Side” Jejunum Beneath the Mesenteric Vessels During a Pancreaticoduodenectomy Quyen D. Chu & Amanda Henderson & Hosein M. Shokouh-Amiri & Gazi Zibari Received: 21 November 2010 / Accepted: 27 January 2011 / Published online: 12 February 2011 # 2011 The Society for Surgery of the Alimentary Tract Abstract Introduction Reflecting the resected portion of the proximal jejunum behind the mesenteric vessels during a pancreaticoduodenectomy (Whipple) procedure can be a challenging maneuver. Methods We describe a simple technique employing a penrose drain that is sutured to the resected “specimen” portion of the jejunum and then pulling it behind the mesenteric vessels. Results Seven patients underwent this procedure over a 2-month period without difficulties. Conclusions This simple technique helps simplify one of the key maneuvers in performing a Whipple procedure. Keywords Whipple . Penrose drain . Pancreaticoduodenectomy Background Pancreaticoduodenectomy (Whipple procedure) for either benign or malignant diseases of the head of the pancreas, distal common bile duct, or duodenum is one of the most complex operations in general surgery. The procedure requires a series of complex maneuvers, one of which is resection of a portion of the proximal jejunum, approxi- mately 10 cm distal to the ligament of Treitz, ligation and division of its mesentery, and then reflecting the resected “specimen side” portion beneath the superior mesenteric artery and vein (mesenteric vessels) so that it will lie on the right side of the body. It should be noted that the proximal jejunal segment to be resected should be freed of its mesentery before pulling it to the patient’s right side. Reflecting the resected jejunum and duodenum can be difficult to perform, especially if the patient is obese or has a large body habitus. Additionally, we have found that, conceptually, it is not easily grasped by a number of surgical residents. Surgical Technique Assuming that the duodenum has already been exten- sively Kocherized and that the resected portion of the jejunum is prepared to be brought to the right side of the patient’s body, a large penrose drain is then delivered posterior to the mesenteric vessels from the right side to the left side of the patient’s body; enough length of the drain should be seen on each side of the body. The drain on the patient’s left is then attached to the “specimen Q. D. Chu : A. Henderson Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA, USA H. M. Shokouh-Amiri : G. Zibari Division of Transplantation, Department of Surgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA, USA Q. D. Chu : H. M. Shokouh-Amiri : G. Zibari Division of Hepato-Pancreato-Biliary, Department of Surgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA, USA Q. D. Chu (*) The Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center in Shreveport, 1501 Kings Highway, Shreveport, LA 71130, USA e-mail: qchu@lsuhsc.edu J Gastrointest Surg (2011) 15:1630–1632 DOI 10.1007/s11605-011-1442-9