Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis.
BACKGROUND
Postoperative pancreatic fistula remains one of the most common and troublesome complications following pancreaticoduodenectomy. No consensus exists regarding the optimal pancreaticojejunostomy reconstruction technique to reduce this complication. We aimed to perform a systematic review comparing two commonly used techniques of pancreaticojejunostomy reconstruction (duct-to-mucosa versus invagination), by meta-analysis and assessment of evidence quality.


METHODS
Databases searched including The Cochrane Library, Medline, PubMed, Embase, etc. Randomized controlled trials (RCTs) comparing duct-to-mucosa and invagination pancreaticojejunostomy were included. Outcomes of interest were pancreatic fistula rate, mortality, morbidity, reoperation and hospital stay. Pooled estimates were expressed as risk ratio (RR) or mean difference.


RESULTS
From 321 identified abstracts, four RCTs (467 patients; duct-to-mucosa: 232; invagination: 235) were included. Pancreatic fistula rate (RR, 0.74; 95% confidence interval (CI): 0.24-2.28; P = 0.60), mortality (RR, 1.18; 95% CI: 0.39- 3.54; P = 0.77), morbidity (RR, 0.91; 95% CI: 0.69-1.21; P = 0.53), reoperation (RR, 1.09; 95% CI: 0.54-2.22; P = 0.81) and hospital stay (mean difference, -1.78; 95% CI: -4.60-1.04; P = 0.22) were similar between techniques.


CONCLUSIONS
Duct-to-mucosa and invagination pancreaticojejunostomy are comparable with regards to assessed parameters. High-quality, large-volume, multi-center RCTs with standard outcome definitions are required.
Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China.
Xue-Li
XL
Bai
Qi
Q
Zhang
Noman
N
Masood
Waqas
W
Masood
Shun-Liang
SL
Gao
Yun
Y
Zhang
Shazmeen
S
Shahed
Ting-Bo
TB
Liang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*