title: Mechanical-stapled versus hand-sutured anastomoses in billroth-I reconstruction with distal gastrectomy.
abstract: OBJECTIVE
  In June 2000, we started performing mechanical-stapled anastomosis (MSA) for Billroth-I reconstruction (B-I) in distal gastrectomy. Thus, we performed a retrospective study to compare the clinical outcome of MSA and conventional hand-sutured anastomosis (HA).
  
  
  METHODS
  We evaluated 103 patients who underwent a B-I reconstruction. The data we collected included operative time, operative blood loss, time until oral intake, postoperative hospital stay, and anastomotic and general complications. We also examined the remnant stomach by endoscopy and classified it according to the Residue, Gastritis, Bile (RGB) criteria.
  
  
  RESULTS
  The operative time was significantly shorter with MSA than with HA, but there were no other significant differences between the two groups. The RGB classification showed that there was more residual stomach content after MSA than after HA. The incidence of gastritis and bile reflux was not significantly different between the two procedures.
  
  
  CONCLUSIONS
  The operative time for B-I reconstruction with distal gastrectomy was significantly shorter with MSA than with HA. While there were no significant disadvantages in the incidence of complications associated with MSA compared with HA, MSA resulted in more residue in the remnant stomach. The findings of this study showed the advantages and disadvantages of MSA, and suggest that MSA and HA are equivalent as anastomotic procedures in B-I reconstruction.
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Takahashi
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Saikawa
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Otani
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kubota
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumai
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome