Two Techniques, One Goal: A Prospective Study on Early Postoperative Outcomes between Stapled and Hand-Sewn Gastrojejunostomy in Distal Gastric Cancer

Author(s): Syeda Mehbuba Joty, Ferdous Alam, Ashok Kumar Sarker, Bidyut Chandra Debnath, Aminul Islam Joarder, SM Syeed-Ul-Alam Sunny, Md. Mahidur Rahman Khan, Fahmida Sultana, Mahbuba Akhter.

Background: Gastrojejunostomy is a critical surgical procedure for patients with gastric cancer. While both stapled and hand-sewn techniques are widely practiced, their comparative efficacy and safety remains a subject of ongoing evaluation.

Methods: This prospective comparative study was conducted in the Department of General Surgery at Enam Medical College and Hospital and Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh, from September 2022 to August 2024. A total of 120 patients undergoing gastrojejunostomy for operable distal (antrum & pylorus) gastric cancer were enrolled and divided into two groups: Group A (stapled, n=60) and Group B (hand-sewn, n=60). Baseline demographic, intraoperative and early postoperative outcomes were analyzed and compared using appropriate statistical tests.

Results: Baseline characteristics such as age, sex, BMI and ASA grades were similar between groups (p > 0.05). The stapled group had significantly shorter operative time (140.5 ± 15.2 vs. 165.3 ± 18.6 minutes, p < 0.001) and anastomotic time (18.2 ± 3.4 vs. 32.5 ± 5.6 minutes, p < 0.001). Time to appear bowel sound, initiation of oral intake and length of hospital stay were significantly improved in the stapled group (p < 0.01). Although surgical site infection and anastomotic leakages were slightly lower in the stapled group, the differences were not statistically significant. Clavien-Dindo complication grading showed comparable safety profiles in both groups.

Conclusion: Stapled gastrojejunostomy offers significant advantages in operative efficiency and early postoperative recovery without increasing complication rates, suggesting it may be a preferred technique for selected patients with distal gastric cancer.