Superiority of stapled side-to-side gastrojejunostomy over conventional hand-sewn end-to-side gastrojejunostomy for reducing the risk of primary delayed gastric emptying after subtotal stomach-preserving pancreaticoduodenectomy

• Published in: Surgery today (Tokyo, Japan) Vol. 47; no. 8; pp. 1007 - 1017
• Main Authors: Murata, Yasuhiro, Tanemura, Akihiro, Kato, Hiroyuki, Kuriyama, Naohisa, Azumi, Yoshinori, Kishiwada, Masashi, Mizuno, Shugo, Usui, Masanobu, Sakurai, Hiroyuki, Isaji, Shuji
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.08.2017
• Subjects: Adult; Aged; Aged, 80 and over; Female; Gastric Bypass - methods; Gastric Emptying; Humans; Laparoscopy - instrumentation; Laparoscopy - methods; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Operative Time; Organ Sparing Treatments - methods; Original; Original Article; Pancreaticoduodenectomy - methods; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Retrospective Studies; Risk; Stomach; Surgery; Surgical Oncology; Surgical Stapling - instrumentation; Surgical Stapling - methods; Suture Techniques; Time Factors; Treatment Outcome; Subtotal stomach-preserving pancreaticoduodenectomy; Delayed gastric emptying; Stapled side-to-side anastomosis; Hand-sewn end-to-side anastomosis
• ISSN: 0941-1291; 1436-2813; 1436-2813
• DOI: 10.1007/s00595-017-1504-z

Background and purpose Delayed gastric emptying (DGE) is the most common complication following pancreaticoduodenectomy (PD). The clinical efficacy of stapled side-to-side anastomosis using a laparoscopic stapling device during alimentary reconstruction in PD is not well understood and its superiority over conventional hand-sewn end-to-side anastomosis remains controversial. The objective of this study was to evaluate the effectiveness of the stapled side-to-side anastomosis in preventing the development of DGE after PD. Methods The subjects of this retrospective study were 137 patients who underwent pancreaticoduodenectomy, as subtotal stomach-preserving pancreaticoduodenectomy (SSPPD; n  = 130), or conventional whipple procedure ( n  = 7) with Child reconstruction, between January 2010 and May 2014. The patients were divided into two groups according to whether they had had a stapled side-to-side anastomosis (SA group; n  = 57) or a conventional hand-sewn end-to-side anastomosis (HA group; n  = 80). Results SA reduced the operative time (SA vs. HA: 508 vs. 557 min, p  = 0.028) and the incidence of delayed gastric emptying (SA vs. HA: 21.1 vs. 46.3%, p  = 0.003) and was associated with shorter hospitalization (SA vs. HA: 33 vs. 39.5 days, p  = 0.007). In this cohort, SA was the only significant factor contributing to a reduction in the incidence of DGE ( p  = 0.002). Conclusions Stapled side-to-side gastrojejunostomy reduced the operative time and the incidence of DGE following PD with Child reconstruction, thereby also reducing the length of hospitalization.