title: Smaller-diameter circular stapler has an advantage in Billroth I stapled anastomosis after laparoscopy-assisted distal gastrectomy.
abstract: BACKGROUND
  Billroth I gastroduodenostomy using a circular stapler is the most preferred reconstruction method after laparoscopy-assisted distal gastrectomy (LADG). The optimal stapler size for this procedure has not yet been proposed.
  
  
  METHODS
  Sixty-five patients who underwent LADG and stapled anastomosis with a 25-mm stapler (25-mm group) and a 29-mm stapler (29-mm group) were enrolled in this study. Clinical data and gastroscopic findings at 6 and 12 months after surgery were retrospectively reviewed.
  
  
  RESULTS
  Postoperative complications and postprandial symptoms were similar in both groups. Gastroscopically, food materials remained more frequently in the remnant stomach in the 25-mm group than in the 29-mm group at 6 months after surgery (P=.041). Gastritis and bile reflux were observed more frequently in the 29-mm group than in the 25-mm group (P=.012 and P=.015, respectively). All these differences in the gastroscopic findings between the two groups decreased at 12 months after surgery except for reflux esophagitis, which was observed more frequently in the 29-mm group (P=.002). The length of the incision was smaller in the 25-mm group than in the 29-mm group (4.39 cm versus 4.95 cm, P=.009).
  
  
  CONCLUSIONS
  A small-diameter stapler is a risk factor for gastric stasis in the early postoperative period, whereas a large-diameter stapler is a risk factor for gastritis and bile reflux in the early postoperative period and for esophagitis in the late postoperative period. Thus, a small-diameter circular stapler has more advantages over a large-diameter circular stapler. It also enables a reliable anastomosis through a smaller incision and easy handling of the stapler during anastomosis.
authors.affiliation: Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Min-Kyoon
authors.initials: MK
authors.lastname: Kim
authors.forename: Joong-Min
authors.initials: JM
authors.lastname: Park
authors.forename: Yoo-Shin
authors.initials: YS
authors.lastname: Choi
authors.forename: Kyong-Choun
authors.initials: KC
authors.lastname: Chi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation*; D005763:Gastroenterostomy / Q000295:instrumentation*; D005773:Gastroscopy; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D013528:Surgical Staplers; D016896:Treatment Outcome