A new attempt to use staples for gastrojejunostomy and Braun anastomosis in modified Child method of pancreaticoduodenectomy

Recent developments in laparoscopic gastrectomy have led to the introduction of various methods of stapled anastomosis. We have also introduced stapled anastomosis to reconstruction of the digestive tract with the aim of performing safe and quick anastomosis and enabling an early return to oral feeding. Reconstruction of the digestive tract following pancreaticoduodenectomy in our institution is performed using the modified Child method. In this procedure, stapled anastomosis is used for gastrojejunostomy and Braun anastomosis, reducing the time required to approximately half the time previously required for hand-sewn anastomosis. Stapled anastomosis did allow a faster return to oral feeding post-operatively, with reduced frequency of delay in gastric emptying compared with hand-sewn anastomosis, but delay in gastric emptying was not completely avoided. This report summarises the procedures and key points raised following the introduction of stapled anastomosis for gastrojejunostomy using the modified Child method and for Braun anastomosis during pancreaticoduodenectomy. While the results of these procedures were satisfactory, many challenges remain and further innovation is required.