Barbed Sutures for Pancreato Jejunum Anastomosis
摘要
Barbed sutures have gained attention for their application in minimally invasive pancreatic surgery, particularly in pancreato-jejunostomy (PJ) after pancreatoduodenectomy. These sutures simplify the suturing process by maintaining consistent tension, ensuring optimal suture placement, and preventing excessive laxity or tension. This technique, advantageous in both laparoscopic and robotic-assisted surgery, is particularly useful in mitigating the challenges posed by the lack of tactile feedback during robotic procedures. The use of barbed sutures in PJ involves a double-layer anastomosis, combining duct-to-mucosa and invagination techniques. The procedure begins with transection of the pancreas and preparation of the jejunal limb. The posterior layer is created with a monofilament absorbable running barbed suture, followed by stenting of the pancreatic duct and jejunal enterotomy. The anterior layers complete the anastomosis, with the jejunum rolled over the pancreas, maintaining the necessary tension throughout. This approach allows for a secure anastomosis, reducing the risk of pancreatic leaks and promoting faster recovery. The progressive tightening of sutures ensures even tension, minimizing parenchymal and capsule lacerations. The use of barbed sutures in robotic and laparoscopic PJ improves surgical efficiency, reduces operating times, and yields outcomes comparable to open surgery, making it a valuable tool in modern pancreatic surgery.