Efficacy of Whipple Procedure with Stapled Bowel Anastomosis: A Safe and Efficient Surgical Approach

Abstract

Background: The anastomosis is the most important part of the surgery as it requires the correct joining of two viable bowel surfaces without tension. Anastomosis of bowel stapled has become a standard procedure in surgery, and it has been found to be more efficient and predictable. This study aims to describe our approach to stapled gastrojejunostomy and jejunojejunostomy in Whipple’s procedure and evaluate the associated clinical outcomes

Method: This retrospective study was conducted from December 2018 to June 2025 on pancreaticoduodenectomy procedures performed by a single surgeon at two institutions. A total of 116 patients who received a stapled anastomosis were included in the study. The data was obtained from existing records, including patient demographics (age and gender), surgical details (such as procedure duration), and post-operative complications, with a focus on anastomotic bleeding and leakage.

Results: A total of 116 patients underwent stapled gastrojejunostomy and entero-enterostomy, including 68 men (58.6%) and 48 women (41.4%). The mean age at the time of surgery was 52 years (±13.93 SD), with a range of 19 to 78 years. There were 3 incidences (2.59%) of bleeding at the site of anastomosis in stapled gastrojejunostomy patients which was confirmed by endoscopy and managed with endo-therapy. There was no incidence of anastomosis leak in stapled anastomosis patients. The average time required to complete the anastomosis using a stapling device was 10 minutes (±1 SD).

Conclusion: In regions with limited stapler utilization, our experience with stapled anastomosis in Whipple surgery highlights its safety, efficiency, and favorable clinical outcomes. The technique was associated with a low incidence of anastomotic complications, no leakage, and minimal bleeding, all managed endoscopically. Additionally, stapler use significantly reduced anastomosis time, enhancing surgical efficiency.