PURPOSE: Many surgeons are using stapled anastomosis in Billroth I gastroduodenostomy after subtotal gastrectomy because of the shorter operation time and simpler handling. However, many patients complain delayed gastric emptying after using EEA stapler. The delayed gastric emptying was compared between manual and stapled anastomosis in Billroth I gastroduodenostomy for stomach cancer. METHODS: 92 patients who performed Billroth I gastroduodenostomy after subtotal gastrectomy due to early gastric cancer at the Hanyang University Guri Hospital between January 2001 to December 2003 were reviewed. Delayed gastric emptying was diagnosed by patients' symptoms and upper gastrointestinal roentgenogram. Manual anastomosis was using the Albert-Lambert suturing and stapled procedure with EEA stapler (auto suture(R)). RESULTS: Of the 92 patients, 22 were in the stapled anastomosis group (a mean age of 61.58 years, M:16, F:6) and 70 in the manually anastomosis group(a mean age of 61.12 years, M: 44, F: 26). The incidence of delayed Gastric emptying were significantly lower in the manual than the stapler group (P=0.035), but the operation times and the hospitas stay were significantly shorter in stapler group (P=0.001 and 0.07, respectively). CONCLUSION: The manual group had better outcomes with regard to gastric emptying despite of the many advantages of stapled anastomosis in the filedld of intraabdominal operations. Various stapled anastomosis instruments and methods have been tried, but further studies are necessary if stapled anastomosis is to be the perfect substitute for manual anastomosis.