Hand-Sewn Anastomosis in Pancreaticoduodenectomy Reduces Delayed Gastric Emptying: Study

In a recent study published in the Surgery journal highlights the superiority of hand-sewn anastomosis for pancreaticoduodenectomy and its impact on delayed gastric emptying. Pancreaticoduodenectomy is a complicated surgical procedure often performed to treat pancreatic cancer and other conditions that involves reconnecting the stomach to the small intestine. The two primary methods for this reconnection are hand-sewn anastomosis and stapled anastomosis, and so, Zhendong Fu and team focused on comparing the efficacy of these methods.

The study was conducted from December 2016 to November 2021 and included 1,077 patients who underwent pancreaticoduodenectomy, where 734 patients received hand-sewn anastomosis and 343 underwent stapled anastomosis. The study identified factors influencing delayed gastric emptying through rigorous analysis and propensity score matching and assessed the efficacy of different anastomotic methods.

The results of the study revealed a clear advantage for hand-sewn anastomosis over the stapled method. The patients in the hand-sewn group experienced a significantly lower incidence of delayed gastric emptying (8.8% vs. 17.2%) and upper gastrointestinal tract bleeding. Also, the participants benefited from shorter postoperative hospital stays and reduced hospitalization expenses, despite the procedure taking longer when compared to the stapled anastomosis.

The logistic regression analysis highlighted stapled anastomosis, intra-abdominal infection and clinically relevant postoperative pancreatic fistula as independent prognostic factors for delayed gastric emptying.

The study emphasized the importance of these findings which underscores the superiority of hand-sewn anastomosis in reducing postoperative complications, particularly delayed gastric emptying. Thereby, surgeons should consider this method to enhance patient outcomes and minimize the risk of complications. These findings contribute significantly to the ongoing debate surrounding the anastomotic techniques in pancreaticoduodenectomy and further studies in larger cohorts will improve the existing understanding.

Reference:

Fu, Z., Gao, S., Wu, X., Qin, J., Dang, Z., Wang, H., Han, J., Ren, Y., Zhu, L., Ye, X., Shi, X., Yin, X., Shi, M., Wang, J., Liu, X., Guo, S., Zheng, K., & Jin, G. (2024). Hand-sewn gastrojejunal anastomosis reduces delayed gastric emptying after pancreaticoduodenectomy: A single-center retrospective clinical study of 1,077 consecutive patients. In Surgery. Elsevier BV. https://doi.org/10.1016/j.surg.2023.12.001