title: The impact of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction on pancreatic fistula after pancreaticoduodenectomy: meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Pancreatic fistula (PF) remains a common source of morbidity following pancreaticoduodenectomy (PD). Despite numerous studies, the optimal method of pancreatic remnant reconstruction is controversial. This study examines the hypothesis that pancreaticogastrostomy (PG) is associated with a lower risk for PF after PD compared with pancreaticojejunostomy (PJ).
  
  
  METHODS
  Five electronic databases and the grey literature were searched for randomized controlled trials (RCTs) comparing PJ and PG after PD. Two reviewers independently selected studies, extracted data and assessed methodology. The primary outcome was the occurrence of PF of International Study Group on Pancreatic Fistula (ISGPF) Grade B or C.
  
  
  RESULTS
  Four RCTs including 676 patients were included. Pancreaticogastrostomy reduced the risk for PF [relative risk (RR) 0.41, 95% confidence interval (CI) 0.21-0.62] without any difference between high- and low-risk patients. Absolute risk reduction for PF was 4% (95% CI 2.4-5.6) in low-risk patients compared with 10% (95% CI 6.5-14.8) in high-risk patients undergoing PG rather than PJ. The strength of evidence for PF outcome was moderate according to the GRADE classification.
  
  
  CONCLUSIONS
  Reconstruction by PG decreases the rate of PF in comparison with PJ. Surgeons should consider reconstructing the pancreatic remnant following PD with PG, particularly in patients at high risk for PF.
authors.affiliation: Division of General Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Hallet
authors.forename: Francis S W
authors.initials: FS
authors.lastname: Zih
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Deobald
authors.forename: Adena S
authors.initials: AS
authors.lastname: Scheer
authors.forename: Calvin H L
authors.initials: CH
authors.lastname: Law
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Karanicolas
mesh_terms: D016063:Blood Loss, Surgical; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D061646:Operative Time; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures