Brief Article
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World J Gastroenterol. Dec 28, 2013; 19(48): 9399-9404
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9399
Stapled gastro/duodenojejunostomy shortens reconstruction time during pylorus-preserving pancreaticoduodenectomy
Norihiro Sato, Kei Yabuki, Shiro Kohi, Yasuhisa Mori, Noritaka Minagawa, Toshihisa Tamura, Aiichiro Higure, Koji Yamaguchi
Norihiro Sato, Kei Yabuki, Shiro Kohi, Yasuhisa Mori, Noritaka Minagawa, Toshihisa Tamura, Aiichiro Higure, Koji Yamaguchi, Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
Author contributions: Sato N and Yabuki K contributed equally to this work; Sato N, Yabuki K and Yamaguchi K designed the research; Sato N, Yabuki K, Kohi S, Mori Y, Minagawa N, Tamura T, Higure A and Yamaguchi K performed the research; Sato N and Yabuki K analyzed the data; Sato N wrote the paper.
Correspondence to: Norihiro Sato, MD, PhD, Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi Ward, Kitakyushu 807-8555, Japan. norisato@med.uoeh-u.ac.jp
Telephone: +81-93-6917441 Fax: +81-93-6032361
Received: May 1, 2013
Revised: October 24, 2013
Accepted: November 2, 2013
Published online: December 28, 2013
Abstract

AIM: To investigate whether a stapled technique is superior to the conventional hand-sewn technique for gastro/duodenojejunostomy during pylorus-preserving pancreaticoduodenectomy (PpPD).

METHODS: In October 2010, we introduced a mechanical anastomotic technique of gastro- or duodenojejunostomy using staplers during PpPD. We compared clinical outcomes between 19 patients who underwent PpPD with a stapled gastro/duodenojejunostomy (stapled anastomosis group) and 19 patients who underwent PpPD with a conventional hand-sewn duodenojejunostomy (hand-sewn anastomosis group).

RESULTS: The time required for reconstruction was significantly shorter in the stapled anastomosis group than in the hand-sewn anastomosis group (186.0 ± 29.4 min vs 219.7 ± 50.0 min, P = 0.02). In addition, intraoperative blood loss was significantly less (391.0 ± 212.0 mL vs 647.1 ± 482.1 mL, P = 0.03) and the time to oral intake was significantly shorter (5.4 ± 1.7 d vs 11.3 ± 7.9 d, P = 0.002) in the stapled anastomosis group than in the hand-sewn anastomosis group. There were no differences in the incidences of delayed gastric emptying and other postoperative complications between the groups.

CONCLUSION: These results suggest that stapled gastro/duodenojejunostomy shortens reconstruction time during PpPD without affecting the incidence of delayed gastric emptying.

Keywords: Pylorus-preserving pancreaticoduodenectomy, Stapled anastomosis, Gastrojejunostomy, Duodenojejunostomy, Delayed gastric emptying

Core tip: The operative procedure of pylorus-preserving pancreaticoduodenectomy (PpPD) includes reconstruction of the pancreatic, biliary, and digestive systems, thus requiring a significant amount of time. We compared clinical outcomes between 19 patients who underwent PpPD with a stapled gastro/duodenojejunostomy and 19 patients who underwent PpPD with a conventional hand-sewn duodenojejunostomy. We demonstrate that stapled gastro/duodenojejunostomy shortens reconstruction time during PpPD without affecting the incidence of delayed gastric emptying.