Which Suture Material is Optimal for Pancreaticojejunostomy Anastomosis? An In Vitro Study

Abstract

None of the suture materials was disintegrated on exposure to pancreatic juice, bile, and their mixture. Polyglactin 910 has the highest breaking strength and significantly loses its strength throughout the experiment but still remains higher than other suture materials. Polypropylene, polydioxanone, and silk showed less variation across the incubation period.

The Choice of the Most Appropriate Suture Threads for Pancreatic Anastomoses on the Basis of Their Mechanical Characteristics

“…In our work, all tests were performed with a single-axial electromagnetic Ultimate Tensile Machine (UTM)—Synergie 200H (MTS System Corporation, Eden Prairie, MN, USA) equipped with a load cell of 100N. The groups of Naleway et al, Karaman et al, and Gierek et al used similar machines and paid attention to settle the suture threads in order to let it break in the middle rather than next to the anchorage knot [ 31 , 35 , 45 ]. However, their system does not have a grip mechanism able to self-align the suture threads during the test, avoiding any misalignments and consequently errors during the acquisition of the stress–deformation curves used to evaluate the UTS and Young’s modulus.…”

“…Tensile tests were carried out through an Ultimate Tensile Machine (UTM) Materials Testing Systems—Synergie 200H (MTS System Corporation, Eden Prairie, MN, USA), which is a single-axial electromagnetic actuation machine equipped with a load cell of 100 N. To avoid misalignment of the suture threads during the test, two test grips were specifically designed. Standard test methods to characterize the properties of suture threads subjected to traction (ASTM D3822/D3822M-14 and ASTM D2256/D2256M-21) [ 40 , 41 ] were followed and integrated with the experiments presented in the literature [ 31 , 33 , 35 , 36 ] in order to create the test-specific protocol for this project.…”

“…In the literature, there are few studies that analyze the suture threads after incubation in biological liquids, and none of these works have a close collaboration between the engineering knowledge and the surgical practical competence in this specific field. In the literature, the analysis of the characteristics of suture thread or other biological liquids was performed independently by engineering groups with low correlation with surgical practice [ 31 , 32 ], or by surgical teams [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ], who pay more attention on the surgical outcomes of their results. On the contrary, the present work is based on a strong collaboration between engineering and surgery in order to obtain a deep correlation between the laboratory results on mechanical tests and the surgical outcomes in the operating room as well as in the post-operative course of patients undergoing pancreatic resections.…”

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

“…The rationale for the choice of a specific suture material should be based on the effects of pancreatic juice and bile on the suture's mechanical features. Two studies 22,28 have explored the effect of both pancreatic juice and bile on the mechanical properties of different suture materials. These studies reported different results, although PDO appears to be the most resistant suture material.…”

The Influence of Various Microenvironmental Factors on Biomechanical Features of Different Suture Materials Used in Hepato-Pancreato-Biliary Surgery

“…Also, because of their structure, polyglycolic sutures were digested by nonactivated pancreatic juice faster than by activated pancreatic juice [9]. Furthermore, in numerous studies it was concluded that synthetic suture materials were better for use in pancreas surgery [15,16].…”