Assessment of Optimal Suture Knot-Tying Force Range for Pancreaticogastrostomy Anastomosis in Pancreaticoduodenectomy

One of the parameters related to the result of Whipple's procedure or Pancreaticoduodenectomy (PD) is the suture knot-tying force during pancreaticogastrostomy anastomosis. We hypothesize that an imbalanced suture force during surgical anastomosis can result in postoperative problems such as postoperative pancreatic fistula (POPF). The consequences are potentially fatal, discouraging the surgeon from conducting such complex surgery. The purpose of this study was to find the best suture knot-tying force for pancreaticogastrostomy anastomosis in PD and to determine the best force range for suture knot-tying to prevent pancreatic leaks. In 36 patients, the designed suture force measurement device (SFD) was clinically evaluated. The patients were monitored postoperatively for any complications, and the suture knot-tying force data were used for analysis. The optimal force range and surgical success had a significant positive connection (P < 0.01). The best suture knot-tying force to avoid pancreatic leak following PD was (3.39 SD0.71) for the soft pancreas, (4.38 SD0.71) for the firm pancreas, and (7.70 SD0.62) for the hard pancreas. Suture knot strength is a significant factor in determining the surgical outcome. A suture knot tied at the optimal force range speeds up healing and avoids other postoperative problems. Suture knots performed beyond the optimal range, on the other hand, were observed with POPF. The study to prevent pancreatic leakage after PD revealed the best suture force range for pancreaticogastrostomy anastomosis. The trial was approved by the Institutional Ethics Committee of Government Stanley Medical College. The Institutional Ethics Committee is reregistered with the Central Drugs Standards Control Organization, ethics committee division with register number ECR/131/Inst/TN/2013/RR19.