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Background and aims: Hemi-double stapling (HDS) for Billroth-I gastroduodenostomy is a simple technique and it has many advantages including reduced operative time and equalization of surgical technique, while potential complications including anastomotic bleeding and stricture. The aim of this study was to retrospectively evaluate the surgical outcome and complications of HDS compared to hand-suture (HS).
Methods: We analyzed 84 patients divided into 2 groups, HDS group with 31 patients and HS group with 53 patients, who underwent B-I reconstruction in open distal gastrectomy between October 2002 and September 2012 in our hospital.
Results: There was no difference between the 2 groups with regard to background factors. In the HDS group, operative time was shorter (113±20 min. v.s. 153±37 min., p<0.01) and blood loss was less (97±90 ml v.s. 161±121 ml, p<0.01) than in the HS group. Postoperative anastomotic bleeding occurred in 4 cases of the HDS group and significantly more than in the HS group (12.9 % v.s. 0 %, p<0.01).All 4 cases needed blood transfusion and 1 case that was unresponsive to conservative management needed endoscopic hemostasis the day after surgery. Anastomotic leakage occurred in 1 case of the HDS group. There were no differences in hospital stay and mortality rate.
Conclusions: HDS reduced operative time and blood loss, but increased postoperative anastomotic bleeding. It is important that we confirm the hemostasis of bleeding from the staple line during surgery and perform endoscopic hemostasis immediately if bleeding is unresponsive to conservative management.