title: Pancreaticogastrostomy versus pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  We conducted this meta-analysis to establish whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better method of reconstruction for reducing the risk of postoperative pancreatic fistula (POPF).
  
  
  METHODS
  This study involved a systematic article search and review of published randomized controlled trials (RCTs) comparing PG vs. PJ after pancreaticoduodenectomy (PD). Cochrane's risk of bias-assessing tool was used to assess the quality of included studies. The fixed-effect model, random-effect model, and subgroup analysis were performed for the sensitivity analysis.
  
  
  RESULTS
  Six RCTs reporting data on 998 patients were included. The incidence of POPF was lower in the PG group (risk ratio, RR = 0.65, 95 % CI 0.43-0.97, P = 0.03), but there was no significant difference in delayed gastric emptying, intra-abdominal fluid collection, biliary fistula, wound infection, postpancreatectomy hemorrhage, overall postoperative complication, or postoperative mortality between the procedures.
  
  
  CONCLUSIONS
  This meta-analysis shows that PG is superior to PJ for reducing the incidence of POPF, but there were no differences in other complications or mortality. Therefore, it may be considered as an alternative to PJ and further RCTs are needed to prove our findings.
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, Liaoning, China, bzmczxb@163.com.
authors.forename: Xianbin
authors.initials: X
authors.lastname: Zhang
authors.forename: Li
authors.initials: L
authors.lastname: Ma
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Gao
authors.forename: Haidong
authors.initials: H
authors.lastname: Bao
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
authors.forename: Ahsen-
authors.initials: A
authors.lastname: Aziz
authors.forename: Zhongyu
authors.initials: Z
authors.lastname: Wang
authors.forename: Peng
authors.initials: P
authors.lastname: Gong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016206:Databases, Bibliographic; D005260:Female; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D055815:Young Adult