title: The impact of pancreatic duct drainage following pancreaticojejunostomy on clinical outcome.
abstract: BACKGROUND
  The aim of this meta-analysis is to evaluate the effect of stenting the pancreatic duct during pancreaticojejunostomy formation on perioperative outcomes.
  
  
  METHODS
  Primary outcome measures were operative mortality and pancreatic fistula. Secondary outcomes were length of hospital stay, reoperation, delayed gastric emptying, estimated blood loss, and length of operation. Internal and external pancreatic stents were grouped together for the purposes of analysis.
  
  
  RESULTS
  Six trials were included in this analysis comprising 732 patients. Pancreatic stent placement had no significant effect on operative mortality; however, there was a non-significant trend towards reduced pancreatic fistula. Estimated blood loss, length of operation, and length of hospital stay were significantly increased in association with pancreatic stent placement. There were no significant effects on reoperation or delayed gastric emptying.
  
  
  CONCLUSIONS
  This analysis demonstrates a trend towards reduced pancreatic fistula with the use of pancreatic stents in pancreaticojejunostomy. However, there were insufficient data to confidently reject the null hypothesis that stenting has no beneficial effect. Further research is required to identify whether in certain subgroups, such as those with soft pancreatic texture and a non-dilated duct, stents may have a more important role in reducing fistula formation.
authors.affiliation: Division of HepatoBiliary and Pancreatic Surgery and Liver Transplantation, Royal Free and University College Hospitals, London, UK. sheraz_markar@hotmail.com
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.forename: Soumil
authors.initials: S
authors.lastname: Vyas
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: Charles
authors.initials: C
authors.lastname: Imber
authors.forename: Massimo
authors.initials: M
authors.lastname: Malago
mesh_terms: D004322:Drainage / Q000295:instrumentation*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000401:mortality; D010193:Pancreaticojejunostomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000517:prevention & control*; D015607:Stents