{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:21:21Z","timestamp":1789762881695,"version":"4.0.1"},"reference-count":10,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Anastomotic failure remains the leading source of morbidity after pancreatoduodenectomy, particularly in patients with a soft pancreas and a small main pancreatic duct. In this high\u2010risk setting, reconstruction is frequently compromised by geometric\n                    <jats:italic>mismatch<\/jats:italic>\n                    between the duct and an oversized jejunal enterotomy, as well as by eccentric duct anatomy that limits safe circumferential suturing. Conventional duct\u2010to\u2010mucosa techniques rely on tissue traction and precise stitch placement, which may be mechanically unstable in fragile glands. We developed a Seldinger\u2010inspired, stent\u2010centered pancreaticojejunostomy designed to address these limitations through geometry preservation and structural stabilization. Instead of cutting the jejunum, the enterotomy is created by controlled puncture and sequential dilation. A biodegradable intraductal stent is introduced over a guidewire, establishing duct\u2013jejunal coaxial alignment. External stabilization is achieved using Blumgart\u2010based fixation and serosal\u2010capsular closure, avoiding ductal traction and circumferential duct\u2010to\u2010mucosa suturing. This technique was applied in a consecutive feasibility series of 15 high\u2010risk patients (soft pancreas and main duct\u00a0\u2264\u00a03\u00a0mm) undergoing minimally invasive pancreatoduodenectomy. The procedure was completed robotically in 14 cases and laparoscopically in one, with no conversions or intraoperative complications. Biochemical pancreatic fistula occurred in 3 patients (20%), with no clinically relevant fistulas. No major complications (Clavien\u2013Dindo\u00a0\u2265\u00a0III) or 90\u2010day mortality were observed. By transforming a fragile duct\u2013bowel interface into a geometry\u2010 and structure\u2010supported reconstruction, this approach appears technically feasible and associated with encouraging short\u2010term safety signals in a highly selected high\u2010risk cohort. These findings should be interpreted as preliminary feasibility data and require validation in larger, multi\u2010operator series.\n                  <\/jats:p>","DOI":"10.1002\/wjs.70311","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T05:11:52Z","timestamp":1773637912000},"page":"1075-1081","source":"Crossref","is-referenced-by-count":1,"title":["The Mismatch Point: A Modified Technique to Prevent and Overcome Duct\u2013Enterotomy Discrepancy in High\u2010Risk Pancreaticojejunostomy"],"prefix":"10.1002","volume":"50","author":[{"given":"Francesca","family":"Marcucci","sequence":"first","affiliation":[{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8534-9823","authenticated-orcid":false,"given":"Alessia","family":"Fassari","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Rennes  Rennes France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Amariutei","sequence":"additional","affiliation":[{"name":"P\u00f4le Sant\u00e9 Sud  Le Mans France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Rosso","sequence":"additional","affiliation":[{"name":"P\u00f4le Sant\u00e9 Sud  Le Mans France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,15]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000003234"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.11.014"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0b013e3181b13ca2"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/bf00311562"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6634"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010014\u20103823\u20102"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595\u2010022\u201002488\u20106"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13304\u2010026\u201002537\u20106"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11701\u2010025\u201002216\u20105"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000006174"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70311","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70311","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70311","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T17:05:17Z","timestamp":1776013517000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,15]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/wjs.70311"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70311","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,15]]}}}