Gastrojejnostomy with Stapling Technique in Billroth II Gastrectomy

Hwang, Shin; Oh, Sung Tae; Yook, Jeong Hwan; Kim, Byung Sik; Park, Kun Choon

Abstract

Various methods of gastrojejunostomy can be used in Billroth II gastrectomy. Two-layer sutures as Albert-Lembert type provide more secure anastomosis and one-layer sutures as Gambee type show better mucosal apposition. To take advantage of merits from the two suture types, we adopted stapling technique in gastrojejunostomy. We have performed 131 cases of stapling gastrojejunostomy and the results were compared with those of 313 conventional manual anastomoses. Stapling gastrojejunostomy consists of partial gastric resection, insertion of GIA stapler forks into jejunal and gastric openings at greater curvatures side, firing, closure of the stapler insertion site and placing reinforcing sutures to the apex of the anastomosis. This method shortened the operation time and did not worsen the postoperative recovery course. Gastrojejunostomy complications requiring laparotomy were occurred in 5 cases(3.8%) in stapling group. Complication cases showed adhesive ileus with efferent loop obstructions, which were resolved by bypass and adhesiolysis. In manual group, 5 cases(1.6%) were undertaken exploration due to adhesive bowel obstructions and anastomosis site bleeding. We concluded that stapling gastrojejunostomy is a safe and faster technique which can replace conventional manual anastomosis.