title: Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The aim of this systematic review was to compare postoperative outcomes between pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy.
  
  
  METHODS
  Six databases were systematically reviewed to identify randomized controlled trials comparing pancreaticogastrostomy and pancreaticojejunostomy. Studies reporting postoperative complications, reoperations, and mortality were included (PROSPERO registration number CRD42013005383).
  
  
  RESULTS
  The search provided a total of 1,646 references. Seven studies were selected including 1,121 patients, 562 in the pancreaticogastrostomy group and 559 in the pancreaticojejunostomy group. Overall incidence of pancreatic fistula and the incidence of more severe fistulas (grade B/C) were lower in the pancreaticogastrostomy group (relative risk 0.67; 95% confidence interval (CI) 0.52 to 0.86; p = 0.002 and relative risk 0.61; 95 % CI 0.40 to 0.93; p = 0.02). Abdominal collections were more frequent in the pancreaticojejunostomy group. However, pancreaticogastrostomy was associated with an increased risk of postoperative intraluminal hemorrhage, and there were no differences in overall morbidity, reoperations, or mortality.
  
  
  CONCLUSIONS
  In this systematic review and meta-analysis, a reduction in the incidence of postoperative pancreatic fistula in the pancreaticogastrostomy group was observed. Although this evidence comes from randomized trials, pancreaticogastrostomy cannot be considered superior to pancreaticojejunostomy due to the presence of clinical heterogeneity among studies and the absence of differences in overall morbidity, reoperations, and mortality.
authors.affiliation: Department of Surgery, "Mancha Centro" General Hospital, Avd. de la Constitución no. 3, 13600, Alcázar de San Juan, Ciudad Real, Spain.
authors.forename: Michael
authors.initials: M
authors.lastname: Clerveus
authors.forename: Antonio
authors.initials: A
authors.lastname: Morandeira-Rivas
authors.forename: Joaquín
authors.initials: J
authors.lastname: Picazo-Yeste
authors.forename: Carlos
authors.initials: C
authors.lastname: Moreno-Sanz
mesh_terms: D006801:Humans; D015994:Incidence; D007902:Length of Stay; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology*; D016577:Pancreaticoduodenectomy / Q000401:mortality; D010193:Pancreaticojejunostomy / Q000401:mortality; D010359:Patient Readmission; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D013270:Stomach / Q000601:surgery*