Journal of Gastrointestinal Surgery

, Volume 20, Issue 3, pp 595–603 | Cite as

Delayed Gastric Emptying After Stapled Versus Hand-Sewn Anastomosis of Duodenojejunostomy in Pylorus-Preserving Pancreaticoduodenectomy: a Randomized Controlled trial

  • Yoshihiro Sakamoto
  • Shutaro Hori
  • Seiji Oguro
  • Junichi Arita
  • Yoji Kishi
  • Satoshi Nara
  • Minoru Esaki
  • Akio Saiura
  • Kazuaki Shimada
  • Takeharu Yamanaka
  • Tomoo Kosuge
Original Article
First Online:
Received:
Accepted:

Abstract

Background

A retrospective analysis indicated that the incidence of delayed gastric emptying (DGE) was less after using a circular stapler (CS) for duodenojejunostomy than that after hand-sewn (HS) anastomosis in pylorus-preserving pancreaticoduodenectomy (PpPD). This randomized clinical trial compared the incidence of DGE postoperative after CS duodenojejunostomy with that of conventional HS anastomosis in PpPD.

Methods

We randomly assigned 101 patients (age 20–80) undergoing PpPD to receive CS duodenojejunostomy (group CS, n = 50) or HS duodenojejunostomy (group HS, n = 51) in two Japanese cancer center hospitals between 2011 and 2013. The patients were stratified by institution and size of the main pancreatic duct (<3 or ≥3 mm). The primary endpoint was the incidence of grade B or C DGE according to the international definition with a non-inferiority margin of 5 %. This trial is registered with University hospital Medical Information Network (UMIN) Center: UMIN000005463.

Results

Per-protocol analysis of data on 95 patients showed that grade B or C DGE was found in 4 (8.9 %) of 45 patients who underwent CS anastomosis and in 8 (16 %) of 50 patients who underwent HS anastomosis (P = 0.015). There were no differences in the overall incidence of DGE (P = 0.98), passage of the contrast medium through the anastomosis (P = 0.55), or hospital stays (P = 0.22).

Conclusions

CS duodenojejunostomy is not inferior to HS anastomosis with respect to the incidence of clinically significant DGE, justifying its use as treatment option.

Keywords

Delayed gastric emptying Pylorus-preserving pancreaticoduodenectomy Circular stapler Hand-sewn Randomized controlled trial 
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Notes

Acknowledgments

The authors express deep gratitude to Dr. Katsuhiko Uesaka, Department of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Dr. Masaru Konishi and Dr. Naoto Gotohda, Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, and Dr. Masaji Hashimoto, Department of Digestive Surgery, Toranomon Hospital, for their critical review of the trial design and manuscripts.

This work is supported in part by Grant-in-Aid for scientific research from the Ministry of Health and Welfare of Japan.

Competing Interests

The authors declare that they have no competing interests.

Disclosure Information

Nothing to disclose

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Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Yoshihiro Sakamoto
    • 1
  • Shutaro Hori
    • 2
  • Seiji Oguro
    • 2
  • Junichi Arita
    • 3
  • Yoji Kishi
    • 2
  • Satoshi Nara
    • 2
  • Minoru Esaki
    • 2
  • Akio Saiura
    • 3
  • Kazuaki Shimada
    • 2
  • Takeharu Yamanaka
    • 4
  • Tomoo Kosuge
    • 2
  1. 1.Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Hepatobiliary and Pancreatic Surgery DivisionNational Cancer Center HospitalTokyoJapan
  3. 3.Department of Gastrointestinal Surgery, Cancer Institute Ariake HospitalJapanese Foundation for Cancer ResearchTokyoJapan
  4. 4.Department of BioethicsYokohama City UniversityYokohamaJapan

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