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

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)595-603
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume20
Issue number3
DOIs
Publication statusPublished - 2016 Mar 1
Externally publishedYes

Fingerprint

Pancreaticoduodenectomy
Gastric Emptying
Pylorus
Randomized Controlled Trials
Hand
Incidence
Information Centers
Cancer Care Facilities
Information Services
Pancreatic Ducts
Contrast Media
Length of Stay

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Delayed Gastric Emptying After Stapled Versus Hand-Sewn Anastomosis of Duodenojejunostomy in Pylorus-Preserving Pancreaticoduodenectomy : a Randomized Controlled trial. / Sakamoto, Yoshihiro; Hori, Shutaro; Oguro, Seiji; Arita, Junichi; Kishi, Yoji; Nara, Satoshi; Esaki, Minoru; Saiura, Akio; Shimada, Kazuaki; Yamanaka, Takeharu; Kosuge, Tomoo.

In: Journal of Gastrointestinal Surgery, Vol. 20, No. 3, 01.03.2016, p. 595-603.

Research output: Contribution to journalArticle

Sakamoto, Yoshihiro ; Hori, Shutaro ; Oguro, Seiji ; Arita, Junichi ; Kishi, Yoji ; Nara, Satoshi ; Esaki, Minoru ; Saiura, Akio ; Shimada, Kazuaki ; Yamanaka, Takeharu ; Kosuge, Tomoo. / Delayed Gastric Emptying After Stapled Versus Hand-Sewn Anastomosis of Duodenojejunostomy in Pylorus-Preserving Pancreaticoduodenectomy : a Randomized Controlled trial. In: Journal of Gastrointestinal Surgery. 2016 ; Vol. 20, No. 3. pp. 595-603.
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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.",
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author = "Yoshihiro Sakamoto and Shutaro Hori and Seiji Oguro and Junichi Arita and Yoji Kishi and Satoshi Nara and Minoru Esaki and Akio Saiura and Kazuaki Shimada and Takeharu Yamanaka and Tomoo Kosuge",
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T2 - a Randomized Controlled trial

AU - Sakamoto, Yoshihiro

AU - Hori, Shutaro

AU - Oguro, Seiji

AU - Arita, Junichi

AU - Kishi, Yoji

AU - Nara, Satoshi

AU - Esaki, Minoru

AU - Saiura, Akio

AU - Shimada, Kazuaki

AU - Yamanaka, Takeharu

AU - Kosuge, Tomoo

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N2 - 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.

AB - 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.

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