title: [Reconstruction methods of digestive tract after pancreaticodudenectomy: a systematic review and meta-analysis of RCTs].
abstract: OBJECTIVE
  To investigate different types of anastomosis and reconstruction techniques after pancreaticodudenectomy with meat-analysis.
  
  
  METHODS
  Systematically literature search was performed through Wanfang, PubMed, EMBASE, Web of Science and Cochrane Library database without restriction to regions, publication types, or languages. A total of 17 randomized controlled trials met the criteria and were evaluated by Jadad scale. Fixed and random-effects models were used to measure the pooled estimates, including pancreatic fistula, bile leakage, hemorrhage, delay gastric emptying(DGE), mortality, reoperation.
  
  
  RESULTS
  Meta analysis revealed that patients undergoing pancreaticogastrostomy had a lower incidence of pancreatic fistula and bile leakage(OR=0.60, 95%CI:0.44-0.82, P=0.001; OR=0.33, 95%CI:0.13-0.82, P=0.02) as compared to pancreaticojejunostomy. In pancreaticoenterostomy group, pancreatic duct-mucosa pancreaticoenterostomy had no significant differences with traditional end-to-end anastomosis in terms of overall postoperative morbidity, and development of postoperative pancreatic fistula, reoperation, perioperative death. External stent placement drainage group had a lower postoperative overall complication rate and incidence of pancreatic fistula, especially the II(-III( grade pancreatic fistula, and a shorter hospital stay than non-stent drainage group(all P<0.05).
  
  
  CONCLUSIONS
  Pancreaticogastrostomy should be recommended as digestive tract reconstruction after pancreaticodudenectomy and assistant external stent drainage is also necessary.
authors.affiliation: Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China. drweihb@126.com.
authors.forename: Purun
authors.initials: P
authors.lastname: Lei
authors.forename: Bo
authors.initials: B
authors.lastname: Wei
authors.forename: Jiafeng
authors.initials: J
authors.lastname: Fang
authors.forename: Jianpei
authors.initials: J
authors.lastname: Liu
authors.forename: Guangsheng
authors.initials: G
authors.lastname: Ou
authors.forename: Lijun
authors.initials: L
authors.lastname: Huang
authors.forename: Hongbo
authors.initials: H
authors.lastname: Wei
mesh_terms: D000714:Anastomosis, Surgical; D004322:Drainage; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D010179:Pancreas; D010193:Pancreaticojejunostomy; D011183:Postoperative Complications; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures; D012086:Reoperation; D015607:Stents