Barbed Suture for Pancreatic Anastomosis during Pancreaticoduodenectomy Decreases Incidence of Clinically Significant Pancreatic Fistula

Background Pancreatic leak continues to be a high cause of morbidity during pancreaticoduodenectomy (PD). Barbed suture is being utilized in many clinical applications due to ease of use and potential higher burst strength of anastomoses. To date, no studies have looked at the impact of utilizing barbed suture in pancreatic reconstruction during pancreaticoduodenectomy. Methods A retrospective analysis was performed of all pancreaticoduodenectomy cases performed by a single surgeon from 2015-2018 at a tertiary care regional medical center. Pancreatic anastomosis was performed as a pancreaticojejunostomy in an end to side fashion; an outer layer of mattress VicrylTM suture was utilized first followed by inner running layer V-lockTM (barbed) suture. No stent was utilized during anastomosis. Fistula rates were recorded in accordance with the International Society of Grading of Pancreatic Fistula (ISGPF) descriptions. Results A total of 49 consecutive pancreaticoduodenectomy performed by a single surgeon were examined. 22 patients had elevated amylase levels (44.9%) Of these, 20/49 Grade A (40.8%), 2/49 Grade B (4.1%), 0/49 Grade C (0%). Conclusion Barbed suture utilization is a reliable and safe method of pancreaticojejunostomy creation during pancreaticoduodenectomy. This technique has a low incidence of clinically relevant pancreatic fistula and is easily producible.


Andrew Guzowski, Joseph N Gabra, Noaman Ali

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