very important and well explaiend by Dr sally.Good pancretic mobilisation just lateral to portal vein is primary step,end to side duct to mucosa  using 4 o prolene with a feeding tube as a stent and stent is sutured to the pancreas.My preference is P-J.Of course if the PD is too small dunking .Somatostatin does help in these cases.One drain at the PJ and an FJ.

duct-to-mucosa, internally protected PJ anastomosis with omental flap between vessels and anastomosis. Non absorbable sutures as stated by Prof Reddy

I finally figure out two solutions for PD, no matter soft pancreatic texture or small pancreatic duct. I prefer end to side PD (dunking technique). No matter soft or hard textures, I use whole thickness mattress sutures. For small duct, don't try to deal with it,  just leave a short stent in it to prevent accidental closure of the p-duct during whole thickness mattress sutures.

Dear Dr. Hodges:

Even using the same term "dunking", actually the techniques to  perform the sutures between the pancreas and jejunum are different and the results and conclusions will be different as well.

I have been doing whole thickness liver parenchyma mattress suture for liver resections by using a long straight needle for more than 18 years, and I was inspired to apply it on pancreatic suture just a year before my retirement. I always can make a very firm tie on liver tissue and I find it is the same to pancreatic tissue, no matter soft or hard, without the fear of lacerating the pancreatic tissue. If you want to further make sure that pancreatic fistula will not happen, you can make an additional raw of whole thickness pancreatic sutures along the one that shown in the figure.

I have been submitted my article to some major journals, but have been rejected owing too few case number. My manuscript is attached. I sincerely hope that it can be performed in your institute.

Sincerely yours,

Dr. Chang