title: Circular stapler size and risk of anastomotic complications in gastroduodenostomy for gastric cancer.
abstract: BACKGROUND
  A Billroth I reconstruction with a mechanically sutured anastomosis is commonly performed in gastric cancer patients. Some surgeons prefer to use large circular staplers during suturing to minimize risks for anastomotic stricture and gastric stasis after surgery. The effect of stapler size on anastomotic complications has not been validated.
  
  
  METHODS
  This study was conducted with 1,031 patients who underwent gastrectomy and Billroth I reconstruction at Samsung Medical Center in Seoul, Korea, between January 2007 and October 2008. Patients were assigned to group A (384 patients) or group B (647 patients) depending on the size of the circular stapler that the surgeon selected for mechanical anastomosis. A 25 mm circular stapler was used for patients in group A, and a 28 or 29 mm circular stapler was used for patients in group B. Postoperative complications were analyzed retrospectively.
  
  
  RESULTS
  The incidence of complications (e.g., gastric stasis, anastomotic stricture, and bleeding) did not differ significantly between groups. Age greater than 60 years was the only significant risk factor for anastomotic complications identified in univariate and multivariate analyses.
  
  
  CONCLUSIONS
  Stapler size was unrelated to complications, such as stricture and gastric stasis. Age was the only significant risk factor for anastomotic complications after gastroduodenostomy.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Dae Hoon
authors.initials: DH
authors.lastname: Kim
authors.forename: Cheong Ah
authors.initials: CA
authors.lastname: Oh
authors.forename: Seung Jong
authors.initials: SJ
authors.lastname: Oh
authors.forename: Min Gew
authors.initials: MG
authors.lastname: Choi
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Noh
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Sohn
authors.forename: Jae Moon
authors.initials: JM
authors.lastname: Bae
authors.forename: Sung
authors.initials: S
authors.lastname: Kim
mesh_terms: D000367:Age Factors; D000368:Aged; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013528:Surgical Staplers; D016896:Treatment Outcome