Does intestinal peristalsis cause suture failure after instrument suture?

Introduction Gastrectomy with lymphadenectomy is a standard treatment for gastric cancer. Anastomotic leakage remains a potentially fatal complication of gastrectomy. Forceful stapler extraction may cause anastomotic complications. We focused on the duodenal peristalsis, as we hypothesized that it might cause forceful stapler extraction. We then retrospectively investigated duodenal peristalsis. We reviewed videos of Da Vinci system cases to clarify the relationship between peristalsis and anastomotic complications. Methods Forty-nine cases with stored videos of laparoscopic surgery using the Da Vinci system from 2015 to March 2021 were included. Peristalsis was defined by repeated contraction and expansion that was clearly visible three or more times in a row, and that there was no peristalsis in other cases. We investigated the duodenum because it is frequently observed during gastrectomy. We evaluated suture failure in cases with and without peristalsis. Results The study population included 49 patients (male, n=32; female, n=17; median age, 71 [42-82] years). Duodenal peristalsis was observed in 14 (28.6%) cases. Three patients experienced complications. A comparative study of cases with and without complications showed significant peristalsis in cases with complications (p=0.0198). Discussion Anastomotic leakage remains a serious and potentially fatal complication of gastrectomy, and surgeons should make efforts to prevent anastomotic leakage. Various risk factors associated with anastomotic leakage have been reported. This is the first retrospective study to evaluate duodenal peristalsis during gastrectomy for gastric cancer. We hypothesized that duodenal peristalsis would apply extreme tension on the stapler. Peristalsis would twist and increase the pressure on the stapler. In this study, we defined a new scale to evaluate duodenal peristalsis. Anastomotic complications were significantly more frequent in cases with peristalsis (p=0.0198). Our results suggest the utility of manual over-sewing or the use of reinforcement material.