title: Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of randomized control trials.
abstract: BACKGROUND
  Postoperative pancreatic fistula (PF) is the leading morbidity after pancreaticoduodenectomy (PD). The pancreatoenteric anastomosis method after PD is associated with the occurrence of PF. Evidence shows that pancreaticogastrostomy (PG) is possibly superior to pancreaticojejunostomy (PJ) in reducing the incidence of PF after PD; however, this remains to be definitively confirmed.
  
  
  METHODS
  Randomized clinical trials (RCTs) comparing the outcomes of PG versus PJ after PD were retrieved for meta-analysis.
  
  
  RESULTS
  After a thorough search of the English literature published until March 23rd, 2014, we identified seven RCTs involving 1095 patients (PG group, 548; PJ group, 547) for final analysis. Meta-analysis revealed that the incidence of PF was significantly lower in the PG group (15.7%) than in the PJ group (23.0%, 126/547; OR = 0.61, 95% CI: 0.45-0.83, P = 0.002). Furthermore, the incidence of intra-abdominal fluid collection was also lower in the PG group than in the PJ group (OR = 0.43, 95% CI: 0.28-0.65, P < 0.0001). No significant differences were found between the PG and PJ groups in terms of delayed gastric emptying, hemorrhage, overall morbidity and mortality.
  
  
  CONCLUSIONS
  PG seemed to be superior to PJ in reducing the incidence of PF and intra-abdominal fluid collection after PD.
authors: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
authors: Z
authors: Z
authors: Chen
authors: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
authors: X
authors: X
authors: Song
authors: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
authors: D
authors: D
authors: Yang
authors: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
authors: Y
authors: Y
authors: Li
authors: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
authors: K
authors: K
authors: Xu
authors: Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China. Electronic address: bigo_sysu@163.com.
authors: Y
authors: Y
authors: He
mesh_terms: D014670:Ampulla of Vater; D000714:Anastomosis, Surgical / Q000379:methods; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D006801:Humans; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome
keywords: Meta-analysis; Pancreatic fistula; Pancreaticoduodenectomy; Pancreaticogastrostomy; Pancreaticojejunostomy