TY - JOUR T1 - Is circular-stapled gastrojejunostomy anastomosis apppropriate for pancreaticoduodenectomy? TT - PANKREATİKODUODENEKTOMİ PROSEDÜRÜNDE GASTROJEJUNUOSTOMİ ANASTOMOZUNUN SİRKÜLER STAPLER İLE YAPILMASI ÖNERİLEBİLİR Mİ? AU - Alkan Kayaoğlu, Sevcan AU - Uzun, Mehmet Ali AU - Erdoğan, Doğan PY - 2024 DA - September DO - 10.19161/etd.1371488 JF - Ege Journal of Medicine JO - EJM PB - Ege University WT - DergiPark SN - 1016-9113 SP - 356 EP - 361 VL - 63 IS - 3 LA - en AB - INTRODUCTION:Pancreaticoduodenectomy is a highly complex procedure that requires surgical experience.. Among these is the use of a stapler in the construction of the gastrojejunostomy anastomosis during the procedure. Our study compares the patient outcomes of gastrojejunostomy anastomosis procedures performed manually and with a circular stapler.MATERIALS AND METHOD:Our study retrospectively evaluated the data of 44 patients who had undergone pancreaticoduodenectomy performed by the same surgical team between May 2015 and December 2019. The manual gastrojejunostomy anastomosis(n = 32) and stapled (circular stapler 25 millimeter) anastomosis(n=12) patient groups were compared for anastomotic stricture.RESULTS:Of the 44 patients undergoing pancreaticoduodenectomy, 68.2% were male, the mean age was 62.9±12.1 years and the mean follow-up was 28.2±21.2 months. The rate of gastrojejunostomy stricture was significantly higher in the circular stapler group (p = 0.017;p < 0.05).CONCLUSION:The increased risk of postoperative pancreatic fistula and anastomotic stricture prevents us from recommending the use of a circular-stapler in the creation of the gastrojejunostomy anastomosis in pancreaticoduodenectomy procedures, as it increases the risk of postoperative pancreatic fistula and anastomotic stricture, and provides no operative time advantage. KW - anostomotic stricture KW - gastrojejunostomy KW - pancreaticoduodenectomy N2 - GİRİŞ:Pankreatikoduodenektomi, cerrahi deneyim gerektiren oldukça karmaşık bir işlemdir. İşlem sırasında gastrojejunostomi anastomozunun yapımında stapler kullanılması bunların arasında yer almaktadır. Çalışmamız elle ve sirküler stapler ile yapılan gastrojejunostomi anastomoz işlemlerinin hasta sonuçlarını karşılaştırmaktadır.GEREÇ VE YÖNTEM: Çalışmamızda Mayıs 2015 ile Aralık 2019 tarihleri arasında aynı cerrahi ekip tarafından pankreatikoduodenektomi yapılan 44 hastanın verileri geriye dönük olarak değerlendirildi. Gastrojejunostomi anastomozu el ile yapılan hasta grubu ile (n=32) ve anastomozu stapler (25 nolu sirküler stapler) ile yapılan hasta grubu(n=12) anastomoz darlığı açısından araştırıldı.BULGULAR:Pankreatikoduodenektomi yapılan 44 hastanın %68,2'si erkekti, yaş ortalaması 62,9±12,1 yıl ve ortalama takip süresi 28,2±21,2 aydı. Gastrojejunostomi darlığı oranı sirküler stapler grubunda anlamlı derecede yüksekti (p = 0,017;p < 0,05).SONUÇ: : Pankreatikoduodenektomi prosedüründe gastrojejunostomi anastomozunun sirküler stapler ile yapılmasını, postoperatif pankreas fistülü ve anastomoz darlığı riskini yükseltmesi, ayrıca operasyon süresi açısından da avantaj sağlamaması nedeniyle önermemekteyiz. CR - 1. Karim S. A. M., Abdulla K. S., Abdulkarim Q. H., & Rahim F. H. (2018). The outcomes and complications of pancreaticoduodenectomy (Whipple procedure): Cross sectional study. International Journal of Surgery, 52, 383–7. https://doi.org/10.1016/j.ijsu.2018.01.041 CR - 2. Clancy T. E., & Ashley S. W. (2005). Pancreaticoduodenectomy (Whipple operation). Surgical Oncology Clinics of North America, 14(3), 533–52. https://doi.org/10.1016/j.soc.2005.05.006 CR - 3. Ball C. G., Pitt H. A., Kilbane M. E., Dixon E., Sutherland F. R., & Lillemoe K. D. (2010). 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