Objective To examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce postoperative complications, especially pancreatic fistula (PF), after pancreaticoduodenectomy (PD). Background PF is a severe complication after PD. The best reconstructive method to reduce occurrence of PF is controversial. We carried out this meta-analysis to compare PG with PJ. Methods A systematic review was conducted on PubMed, EMBASE, and Cochrane Library published up to October 2015 to identify studies comparing PG with PJ. Postoperative complications and mortality were evaluated. A meta-analysis was carried out by Review Manager 5.0. Results 10 RCTs representing 1629 patients (826 PG, 803 PJ) were included. There was a significant difference in favor of PG over PJ (OR 0.72, 95% CI 0.56–0.92, P = 0.009, I 2 = 10%). No significant differences were found in biliary fistula (OR 0.58, 95% CI 0.31–1.06, P = 0.08, I 2 = 38%), DGE (OR 1.08, 95% CI 0.68–1.70, P = 0.75, I 2 = 53%), overall morbidity (OR 0.97, 95% CI 0.77–1.23, P = 0.82, I 2 = 28%), and mortality (OR 0.98, 95% CI 0.60–1.61, P = 0.94, I 2 = 0%). Conclusions The meta-analysis showed a significant difference between PG and PJ on PF: PG was associated with significantly less PF when compared to PJ, indicating that PG is superior to PJ for reconstruction after PD.
Qin, H., Luo, L., Zhu, Z., & Huang, J. (2016, December 1). Pancreaticogastrostomy has advantages over pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy. A meta-analysis of randomized controlled trials. International Journal of Surgery. Elsevier Ltd. https://doi.org/10.1016/j.ijsu.2016.10.020