title: Does antecolic reconstruction for duodenojejunostomy improve delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? A systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate whether antecolic reconstruction for duodenojejunostomy (DJ) can decrease delayed gastric emptying (DGE) rate after pylorus-preserving pancreaticoduodenectomy (PPPD) through literature review and meta-analysis.
  
  
  METHODS
  Articles published between January 1991 and April 2012 comparing antecolic and retrocolic reconstruction for DJ after PPPD were retrieved from the databases of MEDLINE (PubMed), EMBASE, OVID and Cochrane Library Central. The primary outcome of interest was DGE. Either fixed effects model or random effects model was used to assess the pooled effect based on the heterogeneity.
  
  
  RESULTS
  Five articles were identified for inclusion: two randomized controlled trials and three non-randomized controlled trials. The meta-analysis revealed that antecolic reconstruction for DJ after PPPD was associated with a statistically significant decrease in the incidence of DGE [odds ratio (OR), 0.06; 95% CI, 0.02-0.17; P < 0.00001] and intra-operative blood loss [mean difference (MD), -317.68; 95% CI, -416.67 to -218.70; P < 0.00 001]. There was no significant difference between the groups of antecolic and retrocolic reconstruction in operative time (MD, 25.23; 95% CI, -14.37 to 64.83; P = 0.21), postoperative mortality, overall morbidity (OR, 0.54; 95% CI, 0.20-1.46; P = 0.22) and length of postoperative hospital stay (MD, -9.08; 95% CI, -21.28 to 3.11; P = 0.14).
  
  
  CONCLUSIONS
  Antecolic reconstruction for DJ can decrease the DGE rate after PPPD.
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: An-Ping
authors.initials: AP
authors.lastname: Su
authors.forename: Shuang-Shuang
authors.initials: SS
authors.lastname: Cao
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Zhao-Da
authors.initials: ZD
authors.lastname: Zhang
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Hu
authors.forename: Bo-Le
authors.initials: BL
authors.lastname: Tian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004385:Duodenostomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome