A prospective randomized trial of hand-sutured versus mechanically stapled anastomoses for gastroduodenostomy after distal gastrectomy.

BACKGROUND: Although mechanical stapling is now an established alternative to conventional hand suturing for the construction of gastrointestinal anastomoses, its role in gastroduodenostomy remains to be defined. We compared the clinical outcome after mechanical stapling with that after hand suturing in patients who underwent gastroduodenostomy after distal gastrectomy. METHODS: From April 2000 through August 2001, a total of 187 patients with gastric cancer who received distal gastrectomy were randomly assigned to reconstruction by mechanically stapled or by hand-sutured gastroduodenal anastomoses. RESULTS: The baseline clinical characteristics were similar in the patients with mechanically stapled and those with hand-sutured anastomoses. There was no in-hospital mortality in either group. One patient (1.1%) in the mechanically stapled group ( n = 92) and 2 (2.1%) in the hand-sutured group ( n = 95) had anastomotic leakage. Anastomotic stenosis developed in 4 patients (4.3%) who underwent mechanical stapling, as compared with 6 (6.3%) who underwent hand suturing. Anastomotic bleeding occurred in 1 patient (1.1%) who under-went mechanical stapling and 1 patient in the hand-sutured group (1.1%). Mechanical stapling of the anastomoses was significantly quicker than hand-suturing of the anastomoses (median time, 14 vs 25 min; p = 0.02). The two groups were comparable with respect to other outcome measures, including incidence of general complications, recovery of gastrointestinal function, duration of postoperative hospital stay, and radiological diameter of the anastomosis. CONCLUSION: In patients with gastric cancer who undergo gastroduodenostomy after distal gastrectomy, mechanical stapling is quicker than hand suturing. These procedures are similar with respect to anastomotic complications and other outcome measures.