title: Effect of Antecolic versus Retrocolic Gastroenteric Reconstruction after Pancreaticoduodenectomy on Delayed Gastric Emptying: A Meta-Analysis of Six Randomized Controlled Trials.
abstract: BACKGROUND
  One of the most frequent complications of pancreaticoduodenectomy (PD) is delayed gastric emptying (DGE). The study aim was to evaluate the impact of the type of gastro/duodenojejunal reconstruction (antecolic vs. retrocolic) after PD on DGE incidence.
  
  
  METHODS
  A systematic review was made according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing antecolic vs. retrocolic reconstruction were included irrespective of the PD techniques. A meta-analysis was then performed.
  
  
  RESULTS
  Six RCTs were included for a total of 588 patients. The overall quality was good. General risk of bias was low. DGE was not statistically significantly different between the antecolic and retrocolic group (OR 0.6, 95% CI 0.31-1.16, p = 0.13). The other main surgery-related complications (pancreatic fistula, hemorrhage, intra-abdominal abscess, bile leak and wound infection) were not dependent on the reconstruction route (OR 0.84, 95% CI 0.41-1.70, p = 0.63). No statistically significant difference in terms of length of hospital stay was found between the 2 groups. There was also no difference of DGE incidence if only pylorus-preserving PD was considered and between the DGE grades A, B or C.
  
  
  CONCLUSIONS
  This meta-analysis shows that antecolic reconstruction after PD is not superior to retrocolic reconstruction in terms of DGE.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Gaëtan-Romain
authors.initials: GR
authors.lastname: Joliat
authors.forename: Ismaïl
authors.initials: I
authors.lastname: Labgaa
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
authors.forename: Pierre
authors.initials: P
authors.lastname: Allemann
mesh_terms: D005763:Gastroenterostomy / Q000379:methods*; D018589:Gastroparesis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D015233:Models, Statistical; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control