title: Pancreaticogastrostomy is associated with significantly less pancreatic fistula than pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of seven randomized controlled trials.
abstract: OBJECTIVE
  This study aimed to compare pancreaticojejunostomy (PJ) with pancreaticogastrostomy (PG) after pancreaticoduodenectomy (PD).
  
  
  METHODS
  A literature search of PubMed and the Cochrane Central Register of Controlled Trials for studies comparing PJ with PG after PD was conducted. The primary outcome for meta-analysis was pancreatic fistula. Secondary outcomes were morbidity, mortality, biliary fistula, intra-abdominal fluid collection, hospital length of stay (LoS), postoperative haemorrhage and reoperation. Outcome measures were odds ratios (ORs) and mean differences with 95% confidence intervals (CIs).
  
  
  RESULTS
  Seven recent RCTs encompassing 1121 patients (559 PJ and 562 PG cases) were involved in this meta-analysis. Incidences of pancreatic fistula (10.6% versus 18.5%; OR 0.52, 95% CI 0.37-0.74; P = 0.0002), biliary fistula (2.3% versus 5.7%; OR 0.42, 95% CI 0.03-3.15; P = 0.03) and intra-abdominal fluid collection (8.0% versus 14.7%; OR 0.50, 95% CI 0.34-0.74; P = 0.0005) were significantly lower in the PG than the PJ group, as was hospital LoS (weighted mean difference: -1.85, 95% CI -3.23 to -0.47; P = 0.008). Subgroup analysis indicated that severe pancreatic fistula (grades B or C) occurred less frequently in the PG than the PJ group (8.3% versus 20.5%; OR 0.37, 95% CI 0.23-0.59; P < 0.00001). However, there was no significant difference in morbidity (48.9% versus 51.0%; OR 0.90, 95% CI 0.70-1.16; P = 0.41), mortality (3.2% versus 3.5%; OR 0.82, 95% CI 0.43-1.58; P = 0.56), delayed gastric emptying (16.6% versus 14.7%; relative risk: 1.02, 95% CI 0.62-1.68; P = 0.94), postoperative haemorrhage (9.6% versus 11.1%; OR 0.82, 95% CI 0.54-1.24; P = 0.35) or reoperation (9.9% versus 9.8%; OR 0.93, 95% CI 0.60-1.43; P = 0.73).
  
  
  CONCLUSIONS
  Pancreaticogastrostomy provides benefits over PJ after PD, including in the incidences of pancreatic fistula, biliary fistula and intra-abdominal fluid collection and in hospital LoS. Therefore, PG is recommended as a safer and more reasonable alternative to PJ reconstruction after PD.
authors.affiliation: Department of Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Fu-Bao
authors.initials: FB
authors.lastname: Liu
authors.forename: Jiang-Ming
authors.initials: JM
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Geng
authors.forename: Sheng-Xue
authors.initials: SX
authors.lastname: Xie
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Zhao
authors.forename: Li-Quan
authors.initials: LQ
authors.lastname: Yu
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Geng
mesh_terms: D013505:Digestive System Surgical Procedures; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D010180:Pancreatectomy / Q000009:adverse effects; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy