title: Pancreaticogastrostomy has advantages over pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy. A meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce postoperative complications, especially pancreatic fistula (PF), after pancreaticoduodenectomy (PD).
  
  
  BACKGROUND
  PF is a severe complication after PD. The best reconstructive method to reduce occurrence of PF is controversial. We carried out this meta-analysis to compare PG with PJ.
  
  
  METHODS
  A systematic review was conducted on PubMed, EMBASE, and Cochrane Library published up to October 2015 to identify studies comparing PG with PJ. Postoperative complications and mortality were evaluated. A meta-analysis was carried out by Review Manager 5.0.
  
  
  RESULTS
  10 RCTs representing 1629 patients (826 PG, 803 PJ) were included. There was a significant difference in favor of PG over PJ (OR 0.72, 95% CI 0.56-0.92, P = 0.009, I2= 10%). No significant differences were found in biliary fistula (OR 0.58, 95% CI 0.31-1.06, P = 0.08, I2= 38%), DGE (OR 1.08, 95% CI 0.68-1.70, P = 0.75, I2= 53%), overall morbidity (OR 0.97, 95% CI 0.77-1.23, P = 0.82, I2= 28%), and mortality (OR 0.98, 95% CI 0.60-1.61, P = 0.94, I2= 0%).
  
  
  CONCLUSIONS
  The meta-analysis showed a significant difference between PG and PJ on PF: PG was associated with significantly less PF when compared to PJ, indicating that PG is superior to PJ for reconstruction after PD.
authors: Department of Hepatic Surgery, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, PR China.
authors: Han
authors: H
authors: Qin
authors: Department of Hepatic Surgery, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, PR China.
authors: Lin
authors: L
authors: Luo
authors: Department of Hepatic Surgery, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, PR China.
authors: Zexin
authors: Z
authors: Zhu
authors: Department of Hepatic Surgery, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, PR China. Electronic address: huangjiweihxyy@163.com.
authors: Jiwei
authors: J
authors: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
keywords: Pancreaticoduodenectomy; Pancreaticogastrostomy; Pancreaticojejunostomy