A New Feasible Technique for Polytetrafluoroethylene Suture Buttress-Reinforced Pancreaticojejunostomy (PBRP): Mechanical Analysis and a Prospective, Randomized Controlled Trial.

Objectives: Postoperative pancreatic fistula (POPF) is a major concern after pancreatoduodenectomy (PD). We recently designed a new anastomotic method to reduce the rate of pancreatic fistula: polytetrafluoroethylene suture buttress-reinforced pancreaticojejunostomy (PBRP).
Methods: An animal model and a computer simulation were used to measure the maximum stress and tensile strength of the pancreas with and without the suture buttresses. Then, a randomized controlled trial (RCT) was performed to compare the outcome of PD between patients who underwent PBRP vs traditional pancreaticojejunostomy (TP).
Results: The maximum load in the animal model was significantly higher with the suture buttresses than without (5.47 ± 1.67 N vs 3.72 ± 1.36 N, p < 0.01), and in the computer simulation, the peak stress was lower with the suture buttresses than without (54.86 vs 486.8 MPa). There were no significant differences between the two groups in the overall frequency of POPF, but the rate of clinically relevant POPF was significantly lower in the PBRP group (2.8 vs 22.8%, p = 0.028). The pancreaticojejunostomy time was significantly longer in the PBRP group (19.57 ± 3.31 vs 17.17 ± 4.83 min, p = 0.018), and the PBRP group showed a shorter drainage tube retention duration (10 vs 12 days, p = 0.006) and postoperative hospital stay (13 d vs 15 d, p = 0.031).
Conclusions: PBRP is a feasible and reliable procedure for preventing clinically relevant POPF. Additional multi-institution randomized trials should be conducted to confirm these results.