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Comparing the surgical outcomes of stapled anastomosis versus hand-sewn anastomosis of duodenojejunostomy in pylorus-preserving pancreaticoduodenectomy
Ann Hepatobiliary Pancreat Surg 2019 Aug;23(3):245-51
Published online August 31, 2019;
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Dong-Hwan Kim1, Soon-Chan Hong1, Jae-Yool Jang2, Jin-Kyu Cho1, Young-Tae Ju1, Young-Joon Lee1, Eun-Jung Jung2, Sang-Ho Jeong2, Tae-Jin Park2, Ju-Yeon Kim1, Seung-Jin Kwag1, Ji-Ho Park1, and Chi-Young Jeong1

Department of General Surgery, 1Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, 2Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
Received February 7, 2019; Revised April 21, 2019; Accepted April 30, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords : Delayed gastric emptying; Pylorus preserving pancreaticoduodenectomy; Stapled anastomosis; Hand-sewn anastomosis; Duodenojejunostomy


August 2019, 23 (3)