Top

Published in:

01-03-2018 | Original Article

Polyester Preserves the Highest Breaking Point After Prolonged Incubation in Pancreatic Juice

Authors: Stefano Andrianello, Giovanni Marchegiani, Biagio Anselmi, Erica Secchettin, Fabrizio Boriero, Giuseppe Malleo, Roberto Salvia, Claudio Bassi

Published in: Journal of Gastrointestinal Surgery | Issue 3/2018

Abstract

Background

The impact of suture materials on the development of pancreatic fistula after pancreaticoduodenectomy remains unclear. Thus, their choice among pancreatic surgeons is still mostly experience-based. Aim of the present study is to assess what is the best suture material to be used for pancreaticojejunostomy.

Materials and Methods

The force needed to reach the breaking point of five widely used suture materials (polypropylene, polyester, polydioxanone, silk, and polyglactin 910) has been determined through a digital precision dynamometer at baseline and after 5 and 20 days of incubation in pancreatic juice, bile, or a mixture of both.

Results

Regardless of the condition, polyglactin 910 has retained only 10% of its baseline force. Silk has maintained almost 90% of its initial force showing a very low baseline value of force. In pancreatic juice, polypropylene has lost less force compared to polyester (0.25 vs. 0.93 N; p = 0.03) and polydioxanone (0.25 vs. 3.67 N; p = 0.04). Polyester and polydioxanone have showed similar values of force. However, polydioxanone has lost a significant amount of force in pancreatic juice when compared to polyester (0.93 vs. 3.67 N; p = 0.03). Polyester has showed the highest value of force needed to reach the breaking point after 20 days of incubation in pancreatic juice.

Conclusions

After incubation in pancreaticobiliary secretions, polyglactin 910 loses almost all its force. Polypropylene preserves its characteristic, but polydioxanone and polyester show absolute higher breaking points, with polyester retaining the highest value of force needed to reach its breaking point after incubation in pancreatic juice.

Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di Carlo V. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg. 2008;95(3):357–62.CrossRefPubMed

Yoshioka R, Yasunaga H, Hasegawa K, Horiguchi H, Fushimi K, Aoki T, Sakamoto Y, Sugawara Y, Kokudo N. Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy. Br J Surg. 2014;101(5):523–9.CrossRefPubMed

van Heek NT, Kuhlmann KFD, Scholten RJ, de Castro SMM, Busch ORC, van Gulik TM, Obertop H, Gouma DJ. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Annals of Surgery. 2005;242(6):781–8. Discussion 788–90.

Eppsteiner RW, Csikesz NG, McPhee JT, Tseng JF, Shah SA. Surgeon volume impacts hospital mortality for pancreatic resection. Annals of Surgery. 2009;249(4):635–40.CrossRefPubMed

Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364(22):2128–37.CrossRefPubMedPubMedCentral

Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003 Nov 27;349(22):2117–27.CrossRefPubMed

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernández-del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS). The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161(3):584–91.CrossRefPubMed

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007. 142 (5):761–8.CrossRefPubMed

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.CrossRefPubMed

10.

Vollmer CM. The economics of pancreas surgery. Surg Clin North Am. 2013;93(3):711–28.CrossRefPubMed

11.

Zhang X, Ma L, Gao X, Bao H, Liu P, Aziz A, Wang Z, Gong P. Pancreaticogastrostomy versus pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Surg Today. 2015: 45(5):585–94CrossRefPubMed

12.

Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, Mantovani W, Pederzoli P. Reconstruction by Pancreaticojejunostomy Versus Pancreaticogastrostomy Following Pancreatectomy. Annals of Surgery. 2005 Dec;242(6):767–73.CrossRefPubMedPubMedCentral

13.

Chen X-P, Huang Z-Y, Lau JWY, Zhang B-X, Zhang Z-W, Chen Y-F, Zhang W-G, Zhu P, Zhang B. Chen’s U-Suture Technique for End-to-End Invaginated Pancreaticojejunostomy Following Pancreaticoduodenectomy. Ann Surg Oncol. 2014:1–6.

14.

Peng SY, Wang JW, Hong DF, Liu YB, Wang YF. Binding pancreaticoenteric anastomosis: from binding pancreaticojejunostomy to binding pancreaticogastrostomy. Updates Surg. 2011;63(2):69–74.CrossRefPubMed

15.

Fujii T, Sugimoto H, Yamada S, Kanda M, Suenaga M, Takami H, Hattori M, Inokawa Y, Nomoto S, Fujiwara M, Kodera Y. Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. Journal of Gastrointestinal Surgery. 2014;18(6):1108–15.CrossRefPubMed

16.

Malleo G, Bassi C. Pancreas: Reconstruction methods after pancreaticoduodenectomy. Nat Rev Gastroenterol Hepatol. 2013;10(8):445–6.CrossRefPubMed

17.

Martin I, Au K. Does fibrin glue sealant decrease the rate of anastomotic leak after a pancreaticoduodenectomy? Results of a prospective randomized trial. HPB. 2012;15(8):561–6.CrossRefPubMedPubMedCentral

18.

Salvia R, Malleo G, Marchegiani G, Butturini G, Esposito A, Bassi C. Pancreaticoduodenectomy with Harmonic Focus® Curved Shears for Cancer. Dig Surg. 2014;31(4–5):249–54.CrossRefPubMed

19.

Pessaux P, Sauvanet A, Mariette C, Paye F, Muscari F, Cunha AS, Sastre B, Arnaud J-P, Fédération de Recherche en Chirurgie (French). External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial. Annals of Surgery. 2011;253(5):879–85.CrossRefPubMed

20.

Poon RTP, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Annals of Surgery. 2007;246(3):425–33–discussion 433–5.

21.

Motoi F, Egawa S, Rikiyama T. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. British Journal of Surgery. 2012;99(4):524–31.CrossRefPubMed

22.

Nitsche U, Müller TC, Späth C, Cresswell L, Wilhelm D, Friess H, Michalski CW, Kleeff J. The evidence based dilemma of intraperitoneal drainage for pancreatic resection - a systematic review and meta-analysis. BMC Surgery. 2014;14(1):76.CrossRefPubMedPubMedCentral

23.

Molinari E, Bassi C, Salvia R, Butturini G, Crippa S, Talamini G, Falconi M, Pederzoli P. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Annals of Surgery. 2007;246(2):281–7.CrossRefPubMedPubMedCentral

24.

Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Annals of Surgery. 2010;252(2):207–14.CrossRefPubMed

25.

McMillan MT, Malleo G, Bassi C, Sprys MH, Vollmer CM. Defining the practice of pancreatoduodenectomy around the world. HPB (Oxford). 2015 Dec;17(12):1145–54.CrossRef

26.

Topal B, Fieuws S, Aerts R, Weerts J, Feryn T, Roeyen G, Bertrand C, Hubert C, Janssens M, Closset J, Belgian Section of Hepatobiliary and Pancreatic Surgery. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol. 2013;14(7):655–62.CrossRefPubMed

27.

Peng SY, Wang JW, Lau WY, Cai XJ, Mou YP, Liu YB, Li JT. Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Annals of Surgery. 2007;245(5):692–8.CrossRefPubMedPubMedCentral

28.

Xiong JJ, Tan CL, Szatmary P, Huang W, Ke NW, Hu WM, Nunes QM, Sutton R, Liu XB. Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Br J Surg. 2014;101(10):1196–208.CrossRefPubMed

29.

Kamoda Y, Fujino Y, Matsumoto I, Shinzeki M, Sakai T, Kuroda Y. Usefulness of performing a pancreaticojejunostomy with an internal stent after a pancreatoduodenectomy. 2008;38(6):524–8.

30.

Muftuoglu MAT, Ozkan E, Saglam A. Effect of human pancreatic juice and bile on the tensile strength of suture materials. The American Journal of Surgery. 2004;188(2):200–3.CrossRefPubMed

31.

Karaman K, Bal A, Aziret M, Ercan M, Bostanci EB, Akoglu M. Which Suture Material is Optimal for Pancreaticojejunostomy Anastomosis? An In Vitro Study. J Invest Surg. 2016;11(2):1–8.

32.

Andrianello S, Pea A, Pulvirenti A, Allegrini V, Marchegiani G, Malleo G, Butturini G, Salvia R, Bassi C. Pancreaticojejunostomy after pancreaticoduodenectomy: Suture material and incidence of post-operative pancreatic fistula. Pancreatology. 2015;16(1):138–41.CrossRefPubMed

33.

Greenwald D, Shumway S, Albear P, Gottlieb L. Mechanical comparison of 10 suture materials before and after in vivo incubation. Journal of Surgical Research. 1994;56(4):372–7.CrossRefPubMed

34.

Lämsä T, Jin H-T, Nordback PH, Sand J, Nordback I. Effects of diameter, number and tightness of sutures on pancreatic injury response. Dig Surg. 2008;25(4):269–77.CrossRefPubMed

35.

Connor S. Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection. HPB (Oxford). 2016;18(8):642–51.CrossRef

36.

Crippa S, Salvia R, Falconi M, Butturini G, Landoni L, Bassi C. Anastomotic leakage in pancreatic surgery. HPB. 2007;9(1):8–15.CrossRefPubMedPubMedCentral

Title: Polyester Preserves the Highest Breaking Point After Prolonged Incubation in Pancreatic Juice
Authors: Stefano Andrianello
Giovanni Marchegiani
Biagio Anselmi
Erica Secchettin
Fabrizio Boriero
Giuseppe Malleo
Roberto Salvia
Claudio Bassi
Publication date: 01-03-2018
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 3/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3558-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Polyester Preserves the Highest Breaking Point After Prolonged Incubation in Pancreatic Juice

Abstract

Background

Materials and Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Distal Duodenogastrostomy or Proximal Jejunogastrostomy in the Management of Ultra-Short Bowel

The Art of Innovation: an Interview with Yuman Fong, MD

Association Between the Incidence of Pancreatic Fistula After Pancreaticoduodenectomy and the Degree of Pancreatic Fibrosis

Single-Incision Laparoscopic Transgastric Underrunning and Closure of Cameron Ulcers in Acute Gastrointestinal Bleeding

A Hill Gastropexy Combined with Nissen Fundoplication Appears Equivalent to a Collis-Nissen in the Management of Short Esophagus

Hepatic Paragonimiasis Mimicking Hepatocellular Carcinoma