title: Pancreaticogastrostomy is superior to pancreaticojejunostomy for prevention of pancreatic fistula after pancreaticoduodenectomy: an updated meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To review prospective randomized controlled trials to determine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is associated with lower risks of mortality and pancreatic fistula after pancreaticoduodenectomy (PD).
  
  
  BACKGROUND
  Previous studies comparing reconstruction by PG and PJ reported conflicting results regarding the relative risks of mortality and pancreatic fistula after these procedures.
  
  
  METHODS
  MEDLINE, the Cochrane Trials Register, and EMBASE were searched for prospective randomized controlled trials comparing PG and PJ after PD, published up to November 2013. Meta-analysis was performed using Review Manager 5.0.
  
  
  RESULTS
  Seven trials were selected, including 562 patients who underwent PG and 559 who underwent PJ. The pancreatic fistula rate was significantly lower in the PG group than in the PJ group (63/562, 11.2% vs 84/559, 18.7%; odds ratio = 0.53; 95% confidence interval, 0.38-0.75; P = 0.0003). The overall mortality rate was 3.7% (18/489) in the PG group and 3.9% (19/487) in the PJ group (P = 0.68). The biliary fistula rate was significantly lower in the PG group than in the PJ group (8/400, 2.0% vs 19/392, 4.8%; odds ratio = 0.42; 95% confidence interval, 0.18-0.93; P = 0.03).
  
  
  CONCLUSIONS
  In PD, reconstruction by PG is associated with lower postoperative pancreatic and biliary fistula rates.
authors: *Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France †Cancers and Prevention Laboratory, Research Department, University Hospital of Caen INSERM U 1086, Centre François Baclesse, Caen Cedex, France.
authors: Benjamin
authors: B
authors: Menahem
authors: Lydia
authors: L
authors: Guittet
authors: Andrea
authors: A
authors: Mulliri
authors: Arnaud
authors: A
authors: Alves
authors: Jean
authors: J
authors: Lubrano
mesh_terms: D001658:Biliary Fistula / Q000209:etiology / Q000517:prevention & control; D005746:Gastric Emptying; D005774:Gastrostomy; D006801:Humans; D007902:Length of Stay; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors