Gastroduodenostomy after Gastrectomy for Gastric Cancer Comparative study of the single-layer and two-layer sutured anastomosis

ABSTRACT

PURPOSE: The technique of anastomosis for gastroduodenostomy is thought to be of importance to success in the postoperative period and to the development of certain complications. Most surgeons a use two-layer anastomosis method. However, interest in single-layer anastomosis has increased. Therefore, we investigated the differences between single-layer and two-layer methods for anastomosis by comparing clinicopathological parameters and clinical courses. METHODS: This report is a retrospective clinical analysis of 265 patients of gastric cancer who underwent gastroduodenostomy following distal gastrectomy at the Department of Surgery, Chonbuk National University Hospital from Jan. 1991 to Dec. 1999. RESULTS: There was no significant difference observed between the two groups with regard to the mode of presentation, mean age, sex, or pathological characteristics of the tumor. The time for the anastomosis was shorter in the single-layer group (30.1+/-1.0 vs 37.1+/-2.1 minutes, p<0.001), the time of gas out was earlier in the single-layer group (4.4+/-1.1 vs 4.7+/-1.2 days, p=0.027) and the time of food intake was earlier in the single-layer group (5.7+/-0.8 vs 6.3+/-1.4 days, p<0.001) than in the two-layer group. Although the complication rate was not significantly different between the two groups, anastomotic leak was observed in 4 cases (2.7%) of the single-layer group and 3 cases (2.6%) of the two-layer group, and passage disorders were observed in 4 cases (2.7%) of the single-layer group and 5 cases (4.3%) of the two-layer group. CONCLUSION: A gastrodudenostomy using the single-layer anastomosis method has an advantage over the two-layer method for anastomosis with respect to the time for anastomosis, the time of gas out and time of food intake. Therefore the single-layer anastomosis method can be effectively employed in gastric cancer surgery.