Ann Hepatobiliary Pancreat Surg.  2019 Aug;23(3):245-251. 10.14701/ahbps.2019.23.3.245.

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

• Kim DH
• Hong SC
• Jang JY
• Cho JK
• Ju YT
• Lee YJ
• Jung EJ
• Jeong SH
• Park TJ
• Kim JY
• Kwag SJ
• Park JH
• Jeong CY

• KMID: 2456022
• DOI: http://doi.org/10.14701/ahbps.2019.23.3.245

Abstract

BACKGROUNDS/AIMS
This study is to evaluate the perioperative outcomes of the circular stapled method versus the hand-sewn method of the duodenojejunostomy (DJ) procedure in pylorus preserving pancreaticoduodenectomy (PPPD).
METHODS
In this study, as noted between 2010 and 2018, there were 77 PPPDs which were performed at our hospital by one surgeon. We began the circular stapled method from 2014, and continue with this procedure for the aforementioned surgeries including and up to today. The clinical data for the study were collected retrospectively to compare clinical outcomes of the two methods, the circular stapled anastomosis and the hand - sewn anastomosis.
RESULTS
There were 34 patients in a circular stapled group, and 43 in a hand-sewn group as identified for this study. The delayed gastric emptying (DGE) occurred in 6 (17.64%) patients in the circular stapled group, and 10 (23.3%) in the hand-sewn group (p=0.547). It is noted that there was a serum albumin level measured on the 14th day after the operation, which was significantly high in the circular stapled group (3.41±0.47 (g/dl) vs 2.92±0.39 (g/dl), p<0.001). There were no significant differences in terms of the incidence of postoperative complications (58.8% vs 58.1%, p=0.952) and mortality rates (5.9% vs 0, p=0.192) among the patient participants in this study.
CONCLUSIONS
We conclude that using a circular stapler for the DJ procedure in PPPDs do not increase the development of a DGE, and is also helpful for the benefit of the patient's nutritional status going forward during recovery from the operation.

Keyword

Delayed gastric emptying; Pylorus preserving pancreaticoduodenectomy; Stapled anastomosis; Hand-sewn anastomosis; Duodenojejunostomy

MeSH Terms

Gastric Emptying
Hand
Humans
Incidence
Methods
Mortality
Nutritional Status
Pancreaticoduodenectomy*
Postoperative Complications
Pylorus
Retrospective Studies
Serum Albumin
Serum Albumin

Figure

• 

  Fig. 1 Stepwise photo of the stapled duodenojejunostomy. (A) Anvil is inserted to the duodenal stump. (B) The circular stapler is inserted into the afferent jejunal limb through a transversely incised opening. (C) The opening of the afferent jejunal limb is closed using a linear stapler. (D) The completion of the stapled duodenojejunostomy.

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