Effectiveness of duodenal and gastrojejunostomy using suturing devices in pancreaticoduodenectomy

Objective. To study the effect of the formed hardware duodeno– and gastrojejunoanastomoses on the development of gastric emptying retardation. Materials and methods. A study was conducted involving 136 patients from January 2019 to June 2024 who underwent pancreaticoduodenectomy with preservation of the Traverso and removal of the Whipple. Patients were divided into two groups: control group – 102 patients (retrospective part of the study) and main group – 34 patients (prospective part of the study). In turn, patients in the control group were divided into two subgroups: K1 – 26 (25.5%) patients with gastric emptying slowdown and K2 – 76 (74.5%) patients without signs of gastric motor function disorders. The main group was also divided into two subgroups: O1 – 5 (14.7%) patients who developed slowed gastric emptying, and O2 – 29 (85.3%) patients without symptoms of slowed gastric evacuation function. The standard surgical technique was used in the treatment of patients in the control group, and the proposed tactics of forming duodenojejuno– and gastrojejunoanastomoses using suturing devices and measures to prevent the occurrence of gastric emptying retardation in the pre–, intra– and postoperative periods were used in the treatment of patients in the main group. Results. In the case of duodenojejuno– or gastrojejunoanastomosis formation using stapling staplers, the frequency of postoperative delayed gastric emptying decreased from 25.5 to 14.7% (p<0.05), the duration of surgery – from 403 to 362 minutes (p=0.027). The duration of the operation in subgroup K1 was 393 min, K2 – 406 min, in subgroup O1 – 390 min, O2 – 363 min and was not statistically significantly associated with the occurrence of gastrostasis (p = 0.5). The duration of the nasogastric tube stay was shorter in the intervention group than in the control group – 2 and 7 days, respectively (p < 0.0001). The number of days before the start of liquid food intake was also shorter in the intervention group than in the control group – 3 and 7 days, respectively (p < 0.0001). Conclusions. The formation of a stapler anastomosis reduces the risk of delayed gastric emptying after pancreaticoduodenectomy, regardless of whether the gatekeeper was resected, from 25.5 to 14.7% (p<0.05) and accelerates the postoperative recovery of patients with gastrostasis, while not increasing the risk of clinically significant postoperative external pancreatic fistula: 14.7% in the control group and 8.8% in the main group (p=0.001).