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

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4 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)595-603
Number of pages9
JournalJournal of Gastrointestinal Surgery
Issue number3
Publication statusPublished - 2016 Mar 1
Externally publishedYes



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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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