Post-Operative Pancreatic Fistula in Pancreatico-Duodenectomy with Pancreato-Gastrostomy using Barbed Sutures

Objective To demonstrate safety of barbed sutures for pancreatogastrostomy after pancreaticoduodenectomy, analyzing our results with worldwide literature exclusively about post-operative pancreatic fistula, according to the International Study Group for Pancreatic Fistula definition. Methods From 1st January 2013 to 30th June 2015, 39 patients underwent pancreaticoduodenectomy with PG reconstruction (but only 36 using barbed sutures). We evaluated demographic details of the patients (age, sex and diagnosis), length of post-operative hospital stay and rate of POPF. Results Out of 36 patients, 6 patients had a clinically relevant grade B/C fistula (16.6%). B grade postoperative pancreatic fistula occurred in 4 patients (11.1%), managed with fasting and requiring a delayed discharge. Only 2 patients was diagnosed a C grade post-operative pancreatic fistula (5,55%), one requiring a percutaneous computed tomography drain (discharged at 38th post-operative day) and the other one required a re-operation because of a pancreatogastrostomy dehiscence with delayed discharge at 98th post-operative day. Conclusions The use of barbed suture for pancreatogastrostomy reconstruction seems to facilitate the surgical actions and to reduce the rate of post-operative pancreatic fistula after pancreaticoduodenectomy, also in a no high volume center of pancreatic surgery. The results of this observational study should be validated by largest series also inside multicenter randomized trials.