The choice of the most appropriate suture threads for pancreatic anastomoses may play an important role in reducing the incidence of post-operative pancreatic fistula (POPF). The literature on this topic is still not conclusive. The aim of this study was to analyze the mechanical characteristics of suture materials to find the best suture threads for pancreatic anastomoses. A single-axial electromagnetic actuation machine was used to obtain the stress-deformation relationship curves and to measure both the ultimate tensile strength (UTS) and the Young\'s modulus at the 0-3% deformation range (E0-3) of four different suture materials (Poliglecaprone 25, Polydioxanone, Polyglactin 910, and Polypropylene) at baseline and after incubation in saline solution, bile, and pancreatic juice for 1, 3, and 7 days. Polydioxanone and Polypropylene showed stable values of UTS and E0-3 in all conditions. Polyglactin 910 presented significant UTS and E0-3 variations between different time intervals in all types of liquids analyzed. Poliglecaprone 25 lost half of its strength in all biological liquids analyzed but maintained low E0-3 values, which could reduce the risk of lacerations of soft tissues. These results suggest that Polydioxanone and Poliglecaprone 25 could be the best suture materials to use for pancreatic anastomoses. In vivo experiments will be organized to obtain further confirmations of this in vitro evidence.

We comment on a study titled \"Feasibility and safety of \"bridging\" pancreaticogastrostomy for pancreatic trauma in Landrace pigs\" in which ten pigs were randomized to either experimental \"bridging\" pancreaticogastrostomy (PG) or a control group with a routine mucosa-to-mucosa PG. At six months anastomoses had strictured and closed in both groups. The authors concluded that \"bridging\" PG is feasible and safe in damage control surgery during the early stage of pancreatic injury. In this letter we comment on the study design, specifically leaving a 2 cm gap between the pancreatic stump and the stomach and highlight the complexity of performing pancreatic anastomoses following trauma pancreaticoduodenectomy as to our experience in a high volume trauma centre. Our data emphasize that pancreatic anastomoses in trauma are complex procedures with significant postoperative morbidity and are best managed collaboratively by trauma and hepatopancreaticobiliary surgical teams with the required technical skills.