Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2019; 11(7): 322-332
Published online Jul 27, 2019. doi: 10.4240/wjgs.v11.i7.322
Pancreatogastrostomy vs pancreatojejunostomy after pancreaticoduodenectomy: An updated meta-analysis of RCTs and our experience
Yun Jin, Yang-Yang Feng, Xiao-Gang Qi, Geng Hao, Yuan-Quan Yu, Jiang-Tao Li, Shu-You Peng
Yun Jin, Yang-Yang Feng, Xiao-Gang Qi, Geng Hao, Yuan-Quan Yu, Jiang-Tao Li, Shu-You Peng, Department of General Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Author contributions: Li JT and Peng SY conceived and designed the study; Jin Y, Feng YY, and Hao G performed data extraction and statistical analysis; Jin Y, Feng YY, and Qi XG wrote the paper; Yu YQ, Li JT, and Peng SY reviewed and edited the manuscript; all authors read and approved the manuscript.
Supported by Training Project of Health High Level Talents in Zhejiang Province (2014).
Conflict-of-interest statement: We declare that we have no conflict of interest to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jiang-Tao Li, FACS, MD, Attending Doctor, Department of General Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, Zhejiang Province, China. zrljt@zju.edu.cn
Telephone: +86-571-89713729
Received: April 16, 2019
Peer-review started: April 19, 2019
First decision: June 3, 2019
Revised: June 11, 2019
Accepted: June 20, 2019
Article in press: June 21, 2019
Published online: July 27, 2019
Abstract
BACKGROUND

Pancreatoduodenectomy (PD) is one of the most important operations in hepatobiliary and pancreatic surgery.

AIM

To evaluate the advantages and disadvantages of pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG).

METHODS

This meta-analysis was performed using Review Manager 5.3. All clinical randomized controlled trials, in which patients underwent PD with pancreatico-digestive tract reconstruction via PJ or PG, were included.

RESULTS

The search of PubMed, Wanfang Data, EMBASE, and the Cochrane Library provided 125 citations. After further analysis, 11 trials were included from nine counties. In all, 909 patients underwent PG and 856 underwent PJ. Meta-analysis showed that pancreatic fistula (PF) was a significantly lower morbidity in the PG group than in the PJ group (odds ratio [OR] = 0.67, 95% confidence interval [CI]: 0.53-0.86, P = 0.002); however, grades B and C PF was not significantly different between the two groups (OR = 0.61, 95%CI: 0.34-1.09, P = 0.09). Postoperative hemorrhage showed a significantly lower morbidity in the PJ group than in the PG group (OR = 1.47, 95%CI: 1.05-2.06, P = 0.03). Delayed gastric emptying was not significantly different between the two groups (OR = 1.09, 95%CI: 0.83-1.41, P = 0.54).

CONCLUSION

There is no difference in the incidence of grades B and C PF between the two groups. However, postoperative bleeding is significantly higher in PG than in PJ. Binding PJ or binding PG is a safe and secure technique according to our decades of experience.

Keywords: Pancreaticojejunostomy, Pancreaticogastrostomy, Systematic review, Meta-analysis

Core tip: Pancreatico-digestive tract anastomosis after pancreaticoduodenectomy is still controversial. This systematic review and meta-analysis aimed to further evaluate the role and importance of pancreaticojejunostomy and pancreaticogastrostomy. We compared the complications of these two surgical procedures, including pancreatic fistula, delayed gastric emptying, and hemorrhage.