Is circular-stapled gastrojejunostomy anastomosis apppropriate for pancreaticoduodenectomy?

Abstract

INTRODUCTION:Pancreaticoduodenectomy is a highly complex procedure that requires surgical experience.. Among these is the use of a stapler in the construction of the gastrojejunostomy anastomosis during the procedure. Our study compares the patient outcomes of gastrojejunostomy anastomosis procedures performed manually and with a circular stapler. MATERIALS AND METHOD:Our study retrospectively evaluated the data of 44 patients who had undergone pancreaticoduodenectomy performed by the same surgical team between May 2015 and December 2019. The manual gastrojejunostomy anastomosis(n = 32) and stapled (circular stapler 25 millimeter) anastomosis(n=12) patient groups were compared for anastomotic stricture. RESULTS:Of the 44 patients undergoing pancreaticoduodenectomy, 68.2% were male, the mean age was 62.9±12.1 years and the mean follow-up was 28.2±21.2 months. The rate of gastrojejunostomy stricture was significantly higher in the circular stapler group (p = 0.017;p < 0.05). CONCLUSION:The increased risk of postoperative pancreatic fistula and anastomotic stricture prevents us from recommending the use of a circular-stapler in the creation of the gastrojejunostomy anastomosis in pancreaticoduodenectomy procedures, as it increases the risk of postoperative pancreatic fistula and anastomotic stricture, and provides no operative time advantage.