Staplers in palliative bypass surgery for unresectable pancreatic cancer

To assess the role of stapling devices and routine gastroenterostomy in palliative bypass surgery, the hospital records of 150 consecutive patients with unresectable, histologically proven pancreatic adenocarcinoma requiring palliative bypass procedure were reviewed. During recent years staplers have gained increasing acceptance for construction of palliative anastomoses. Mortality and morbidity were lower after stapled anastomoses. The use of staplers for construction of double bypass reduced the operation time by 45 min (p less than 0.001). After initial biliary diversion 6% of the patients required later reoperation for gastric outlet obstruction. Routine gastroenterostomy made reoperation unnecessary. Delayed gastric emptying occurred, however, in 10% and significant upper gastrointestinal bleeding in 7% of the patients after prophylactic gastroenterostomy. We conclude that stapling devices are safe and practical in palliative bypass surgery and they significantly reduce operation time if more than one bypass is required. The relatively high incidence of delayed gastric emptying, and significant upper gastrointestinal bleeding after prophylactic gastroenterostomy and the infrequent occurrence of gastric outlet obstruction after initial biliary bypass together with the low mortality after reoperation, suggest that gastroenterostomy should be performed on a selective basis only.