Hand-sewn versus Stapled Anastomosis for Billroth II Gastrojejunostomy After Distal Gastrectomy: Comparison of Short-term Outcomes

Introduction: Subtotal gastrectomy is usually performed in patients with distal gastric cancer. After distal gastrectomy, which reconstruction method can be used is still controversial. This study evaluated the effect of the stapler and hand-sewn techniques on postoperative results. Methods: Patients who underwent distal gastrectomy in a single center were evaluated retrospectively in this study. Patients who underwent the Billroth II reconstruction method were analyzed. Hand-sewn and stapled techniques were compared in terms of operative and short-term postoperative outcomes. Results: Two hundred fourteen patients were included. Most of the patients (66.8%) were male. The median age was 61 years. Billroth-II reconstruction with hand-sewn was performed in 161 (75%) patients, and the double stapler technique was performed in 53 (25%) patients. When the hand-sewn and stapled groups were compared, no difference was found in age, sex, or American Society of Anesthesiology scores. There was no difference in choosing antecolic or retrocolic as the surgical technique (p=0.19). A shorter length of hospital stay was detected in the stapled group (p=0.01). The overall complication rate was higher in the hand-sewn group (21.7% vs. 7.5%, p=0.02). Clavien-Dindo grade 3 and above complications were significantly higher in the hand-sewn group (13.7% vs. 3.8%, p=0.02). Conclusion: Our study showed that the stapler anastomosis technique for Billroth II gastrojejunostomy after distal gastrectomy led to fewer overall complications and shortened hospital stays.