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

Abstract

Background and purposeDelayed 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.MethodsThe 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).ResultsSA 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).ConclusionsStapled 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.

Comparing the surgical outcomes of stapled anastomosis versus hand-sewn anastomosis of duodenojejunostomy in pylorus-preserving pancreaticoduodenectomy

“…Previous researchers have reported that use of staplers for anastomosis does not increase postoperative complications in PD,67814171822 and we also observed this as well in the present study. The prevailing discipline notes that staple alimentary reconstruction is now widely used in upper and lower gastrointestinal tract surgery 323.…”

“…Other researchers have compared stapled anastomosis with hand-sewn anastomosis 61718. Sakamoto et al6 (2016) have reported that Roux-en-Y reconstruction using a stapler in PD was not inferior to the hand-sewn method in terms of incidence of DGE, and we found favorable results of stapled anastomosis for DJ in PPPD in terms of DGE incidence.…”

“…For this reason, a stapled anastomosis has theoretical advantages, such as that it does not require clamping of the intestinal tube, which is necessary during hand-sewn procedures, and it creates a single layer of anastomosis, whereas the hand-sewn method requires a double layer. These differences may cause fewer incidences of bowel edema and better blood supply to the region, which are favorable for decreasing the incidence of DGE 1617…”

<p>Effect of Rikkunshito, a Traditional Japanese Herbal Medicine, on Delayed Gastric Emptying and Oral Dietary Intake After Pancreaticoduodenectomy: A Prospective, Randomized, Single-Center, Open-Labeled Study</p>

“…Regarding improvements in outcomes after PD, it should be noted that the median duration of hospital stay in this study was longer than that in most Western countries, although the results were almost compatible with hospital stay durations from other studies in Japan, which ranged from 18 to 39.5 days. 1,7,8,12,13,38 Differences in the health care insurance systems and medical expenses might influence postoperative care and patients behaviors, as discussed in other studies from Japan. 1,7,12,13 This study had several limitations.…”

“…In general, surgical procedures influenced DGE, indicating the superiority of pylorus resection, 7 antecolic gastrojejunostomy or duodenojejunostomy reconstruction, 8 Braun anastomosis, 9 Billroth II reconstruction 10,11 and side-to-side gastrojejunostomy. 12,13 However, recent studies including a meta-analysis reported conflicting findings, [2][3][4][14][15][16] resulting in a lack of evidencebased effective procedures that decrease DGE consistently. Few studies have focused on pharmacological treatment for DGE after PD.…”