Barbed Suture for Pancreaticojejunal Anastomosis: An Ally Against Pancreatic Fistula

Pancreaticoduodenectomy (PD) is the standard treatment for resectable pancreatic head disease. The pancreatic anastomosis constitutes the mainstay of this procedure and is one of the drivers of its morbidity. Despite the development of a variety of techniques for pancreaticojejunostomy or pancreaticogastrostomy, high rates of postoperative pancreatic fistula (POPF), hampering early and fast patient recovery, are still reported. Here, based on the analysis of a cohort of 16 patients operated over 2 years, we describe a pancreaticojejunal anastomosis technique taking advantage of unidirectional barbed sutures. Although six of these patients were classified as "high risk," according to updated International Study Group of Pancreatic Fistula (ISGPS) recommendations, we only observed one grade B POPF requiring antibiotic treatment, prolonged fasting and parenteral nutrition during the postoperative course. While larger studies are necessary to clarify this issue, our data suggests that barbed sutures could help prevent POPF development following PD.