Avoiding the knot: the no-knots pancreatojejunostomy for redistribution of traction forces on the pancreatic parenchyma.

This proof-of-concept study describes a novel "no-knots" pancreatojejunostomy technique designed to minimize parenchymal injury by avoiding knot-tying on the pancreatic capsule. Instead of knot-tying, the method uses interrupted sutures anchored with clips to redistribute traction forces evenly along the pancreatic surface. Between January 2024 and July 2025, 40 consecutive pancreatoduodenectomies were performed using this approach. The pancreatic anastomosis was completed in all patients without technical failure. Four patients (10%) developed a postoperative pancreatic fistula (all grade B), which was managed conservatively. The no-knots technique proved feasible and safe across a range of gland textures and duct diameters. Its simplicity and potential to minimize tissue injury support further investigation in controlled studies.