Roux-en-Y reconstruction using staplers during pancreaticoduodenectomy: results of a prospective preliminary study.

PURPOSE: The aim of this study was to reveal the utility of alimentary reconstruction using staplers during pancreaticoduodenectomy (PD), focusing on the occurrence of delayed gastric emptying. METHODS: Between 2003 and 2007, 72 PDs with alimentary reconstruction were performed by a single surgeon. Since August 2006, the new Roux-en-Y reconstruction methods using staplers were applied in 26 of the patients. We compared their clinical outcomes with those of the 46 patients who underwent PD using the conventional hand-sewn reconstruction methods. RESULTS: The results of upper gastrointestinal study showed improvement within 10 postoperative days (PODs; P = 0.03): the patients resumed eating their regular diet sooner (13 vs 6 days, P < 0.001), and both the incidence of delayed gastric emptying (43% vs 19%, P = 0.04) and the hospital stay (27 vs 21 days, P = 0.008) were reduced significantly in patients with stapled reconstruction. Despite the fact that operative costs were significantly higher for patients with stapled reconstruction (P = 0.009), hospital costs were significantly lower (P = 0.049) for those who underwent the conventional method. CONCLUSIONS: Our retrospective analysis shows that stapled reconstructions might reduce the incidence of delayed gastric emptying; however, further study will be necessary to evaluate the utility of this new method.