Comparative analysis of the eff ectiveness of manual and mechanical methods of duodenoenteroanastomosis formation in pancreaticoduodenectomy with preservation of the gatekeeper

Objective. To compare the clinical results of manual and mechanical stapler–assisted duodenal anastomosis in pancreatoduodenectomy with preservation of the pylorus. Materials and methods. The study included 79 patients who underwent pancreatoduodenectomy with preservation of the pylorus between March 2021 and February 2024. Depending on the method of anastomosis formation, the patients were divided into two groups: the first group consisted of 50 patients in whom duodenal anastomosis was formed manually, and the second group consisted of 29 patients in whom duodenal anastomosis was formed using a mechanical stapler. Results. In cases of mechanical duodenoenterostomy, the duration of surgery averaged 362 minutes and was shorter than in cases of manual duodenoenterostomy (403 minutes), with a statistically significant difference (p = 0.004). Also, in the second group, the duration of nasogastric tube use was significantly shorter than in the first group, 2 and 7 days, respectively (p= 0.0001), and the time to the start of enteral nutrition was 3 and 7 days, respectively (p= 0.0001). Conclusions. The mechanical method of forming a duodenoenterostomy is safe and technically feasible, allows a statistically significant reduction in the duration of surgery compared with the standard manual technique, and is not associated with an increased risk of complications. A statistically significant difference was found between the study groups in the frequency of delayed gastric emptying and the occurrence of postoperative pancreatic fistula. The use of stapling devices enables standardization of the technique, reduction of human–related variability, and higher reproducibility of the procedure. This approach is promising, especially in centers with a high surgical workload, where efficiency is critical to maintaining patient safety.