title: Quantitative assessment and determinants of suture-holding capacity of human pancreas.
abstract: BACKGROUND
  Hard pancreas is welcome by surgeons performing resective pancreatic surgery, because it is believed to offer better suture holding capacity (SHC), thus decreasing the risk for a postoperative leak. However, neither the actual SHC of pancreatic tissue in humans nor its determinants have been studied.
  
  
  METHODS
  We directly measured SHC for polydioxanone 5-0 suture and tissue hardness at the pancreatic isthmus in 53 human pancreata using a dynamometer and a durometer. A histologic score based on fibrosis grade, fat content, pancreatic duct size, and signs of chronic pancreatitis was calculated for every sample. We tested the hypothesis that SHC of the pancreas was proportional to tissue hardness, and evaluated the role of different possible histomorphologic determinants of SHC.
  
  
  RESULTS
  Suture-holding capacity correlated perfectly with tissue hardness (r = 0.98; P < 0.001; 95% confidence interval, 0.96-0.99). The histologic score showed a stronger correlation with both parameters than any single histologic parameter. The SHC of transductal sutures was significantly higher than that of pure transparenchymal sutures. The SHC and hardness were significantly lower in patients who developed a clinically relevant pancreatic fistula postoperatively.
  
  
  CONCLUSIONS
  A mixture of histomorphologic features of human pancreas determines its tissue hardness and SHC. Involvement of the main pancreatic duct in the suture line appears to increase the mechanical strength of the pancreatic anastomosis.
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr University of Bochum, Bochum, Germany. Electronic address: orlibel@hotmail.com.
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.forename: Sonja
authors.initials: S
authors.lastname: Rosenkranz
authors.forename: Johanna
authors.initials: J
authors.lastname: Munding
authors.forename: Torsten
authors.initials: T
authors.lastname: Herzog
authors.forename: Ansgar M
authors.initials: AM
authors.lastname: Chromik
authors.forename: Andrea
authors.initials: A
authors.lastname: Tannapfel
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005355:Fibrosis; D006244:Hardness; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology* / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000473:pathology / Q000601:surgery; D016687:Polydioxanone / Q000009:adverse effects / Q000592:standards*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013314:Stress, Mechanical; D013537:Sutures / Q000009:adverse effects / Q000592:standards*
chemical_list: D016687:Polydioxanone
keywords: Durometer; Dynamometer; Hardness; Histologic score; Pancreas; Pancreatoduodenectomy; Suture-holding capacity