Barbed sutures for hepaticojejunostomy in robotic pancreatoduodenectomy: a case-matched analysis

Background: Limited data are available on the impact of suture type on hepaticojejunostomy (HJ) outcomes during robotic pancreatoduodenectomy (RPD). This study compares biliary complications, specifically biliary leak (BL), and biliary anastomotic stricture (BAS), associated with barbed sutures (BS) versus conventional sutures (CS). Methods: A retrospective analysis was performed on patients who underwent RPD at our General Surgery Unit within the Multidisciplinary Center for Robotic Surgery in Pisa from May 2018 to December 2024. Two matched groups (bsHJ group and csHJ group) were formed using 1:1 matching based on patient characteristics, preoperative biliary drainage rate, histology, and bile duct diameter. Operative HJ time, post-operative outcomes, and mid-term results were compared. Results: The analysis included 90 patients, 45 in each group. The bsHJ group demonstrated a significantly lower BL rate (0/45, 0.0% vs. 4/45, 8.9%; p = 0.04) and shorter operative time (15.4 ± 4.5 min vs. 18.3 ± 4.6 min; p = 0.004) compared to the csHJ group. During follow-up, BAS occurred in five cases (11.6%) in the csHJ group and three cases (6.9%) in the bsHJ group (p = 0.262). No significant differences were observed in post-operative hospital stay or other major complications. Conclusion: The use of BS for HJ in RPD enhances intraoperative efficiency and appears to lower BL rates without increasing the incidence of BAS.