Suture material in pancreticojejunal anastomosis: a systematic review

Post-operative pancreatic fistula is a common and morbid complication of pancreaticojejunal anastomosis. While gastrointestinal anastomosis is typically performed using absorbable sutures, this issue has prompted experimentation with non-absorbable sutures. This study aims to assess the available literature to provide recommendations on suture choice in this anastomosis.

Two independent reviewers performed searches of EMBASE, MEDLINE, PubMed, Google Scholar, and the Cochrane Library of Systematic Review. References were screened for additional articles. Articles comparatively assessing suture choice in pancreaticojejunal anastomosis were included.

Of 2237 records screened, nine articles were included in this review. Suture materials assessed include polydioxanone, polyglactin 910, polyglycolic acid, polypropylene, polyester, silk, nylon, plain and chromic catgut, and polybutester. Clinical studies suggested polyester reduced rates of fistula formation. Ex vivo findings favoured polydioxanone and polyglactin 910. 5-0 was found to be favourable to 6-0 in duct-to-mucosa anastomosis with monofilament absorbable sutures. Barbed sutures were suggested to reduce fistula formation. Limitations were identified in many of the included articles.

There is limited research available on this topic, and it is not possible to strongly recommend any single suture as superior to others. Polyester is promising in clinical studies, and would benefit from further studies assessing validity. Polydioxanone and polyglactin 910 have rational indications for use. In particular, polydioxanone is suggested when poor healing is expected. Barbed sutures may reduce rates of fistula formation. More research is required to draw a strong conclusion.