{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:54:26Z","timestamp":1787068466947,"version":"build-2736575974"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post\u2010operative pancreatic fistula is a common and morbid complication of pancreaticojejunal anastomosis. While gastrointestinal anastomosis is typically performed using absorbable sutures, this issue has prompted experimentation with non\u2010absorbable sutures. This study aims to assess the available literature to provide recommendations on suture choice in this anastomosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two independent reviewers performed searches of EMBASE, MEDLINE, PubMed, Google Scholar, and the Cochrane Library of Systematic Review. References were screened for additional articles. Articles comparatively assessing suture choice in pancreaticojejunal anastomosis were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 2237 records screened, nine articles were included in this review. Suture materials assessed include polydioxanone, polyglactin 910, polyglycolic acid, polypropylene, polyester, silk, nylon, plain and chromic catgut, and polybutester. Clinical studies suggested polyester reduced rates of fistula formation. Ex vivo findings favoured polydioxanone and polyglactin 910. 5\u20130 was found to be favourable to 6\u20130 in duct\u2010to\u2010mucosa anastomosis with monofilament absorbable sutures. Barbed sutures were suggested to reduce fistula formation. Limitations were identified in many of the included articles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There is limited research available on this topic, and it is not possible to strongly recommend any single suture as superior to others. Polyester is promising in clinical studies, and would benefit from further studies assessing validity. Polydioxanone and polyglactin 910 have rational indications for use. In particular, polydioxanone is suggested when poor healing is expected. Barbed sutures may reduce rates of fistula formation. More research is required to draw a strong conclusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.19408","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T02:40:11Z","timestamp":1738118411000},"page":"321-327","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Suture material in pancreticojejunal anastomosis: a systematic review"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7883-9135","authenticated-orcid":false,"given":"Douglas","family":"Chung","sequence":"first","affiliation":[{"name":"General Surgical Department Liverpool Hospital  Corner of Elizabeth and Goulburn Street Liverpool New South Wales 2170 Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supun","family":"Bakmiwewa","sequence":"additional","affiliation":[{"name":"General Surgical Department Liverpool Hospital  Corner of Elizabeth and Goulburn Street Liverpool New South Wales 2170 Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arul","family":"Suthananthan","sequence":"additional","affiliation":[{"name":"General Surgical Department Sir Charles Gairdner Hospital  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1280-153X","authenticated-orcid":false,"given":"Marwan","family":"Idrees","sequence":"additional","affiliation":[{"name":"General Surgical Department Liverpool Hospital  Corner of Elizabeth and Goulburn Street Liverpool New South Wales 2170 Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"e_1_2_8_2_1","article-title":"Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction for the post\u2010operative pancreatic fistula following pancreaticoduodenectomy","volume":"9","author":"Cheng Y","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_8_3_1","first-page":"S103","article-title":"Early biliary fistula after pancreatoduodenectomy as a cause of morbidity and mortality: literature review and personal experience","volume":"37","author":"Motelchuk S","year":"2023","journal-title":"Surg. Endosc."},{"key":"e_1_2_8_4_1","first-page":"41","article-title":"Physiology of anastomotic healing","volume":"82","author":"Marjanovic G","year":"2011","journal-title":"Die Chi."},{"key":"e_1_2_8_5_1","first-page":"1","article-title":"Which suture material is optimal for Pancreaticojejunostomy anastomosis? An in vitro study","volume":"0","author":"Karaman K","year":"2016","journal-title":"J. Investig. Surg."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2018.04.007"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.141.4.361"},{"key":"e_1_2_8_8_1","unstructured":"PRISMA2020Checklist. [Cited March 2024.] Available from URL:www.prisma-statement.org\/prisma-2020-checklist."},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.11.014"},{"key":"e_1_2_8_10_1","volume-title":"The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses","author":"Wells G","year":"2021"},{"key":"e_1_2_8_11_1","volume-title":"Critical Appraisal Checklists: CASP Systematic Review Checklist","author":"Critical Appraisal Skills Programme (CASP)","year":"2018"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2015.11.004"},{"key":"e_1_2_8_13_1","first-page":"1053","article-title":"Which suture to choose in Hepato\u2010pancreatic\u2010biliary surgery? Assessment of the influence of pancreatic juice and bile on the resistance of suturing materials \u2010 in vitro research","volume":"10","author":"Gierek M","year":"2022","journal-title":"Biomedicine"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2003.12.068"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-017-3558-z"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197712000-00009"},{"key":"e_1_2_8_17_1","first-page":"1368","article-title":"Technical and mechanical risk factors for postoperative pancreatic fistula in pancreaticojejunostomy","volume":"58","author":"Nojiri T","year":"2011","journal-title":"Hepato\u2010Gastroenterology"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-024-11163-5"},{"key":"e_1_2_8_19_1","first-page":"95","article-title":"The influence of various microenvironmental factors on biomechanical features of different suture materials used in Hepato\u2010Pancreato\u2010biliary surgery","volume":"21","author":"Radojkovic M","year":"2019","journal-title":"Med. 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