Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy.

Background Surgical reconstruction following pancreaticoduodenectomy ( PD) is associated with significant morbidity and mortality. Because of great variability in definitions of specific complications, it remains unclear whether there is a difference in complication rates following the two commonest types of reconstruction, pancreaticogastrostomy ( PG) and pancreaticojejunostomy ( PJ). Published consensus definitions for postoperative pancreatic fistula ( POPF) have led to a series of randomized clinical trials ( RCTs) uniquely placed to address this question. Methods A literature search was carried out to identify all RCTs comparing postoperative complications of PG versus PJ reconstruction following PD published between January 1995 and December 2013. Pooled odds ratios ( ORs) with 95 percent confidence intervals (c.i.) were calculated using fixed-effect or random-effects models. Results In total, seven RCTs with 1121 patients were included. Four of these trials applied definitions as published by the International Study Group on Pancreatic Fistula ( ISGPF). Using ISGPF definitions, the incidence of POPF was lower in patients undergoing PG than in those having PJ ( OR 0·50, 95 per cent c.i. 0·34 to 0·73; P < 0·001). Using definitions applied by each individual study, PG was associated with significantly lower rates of POPF ( OR 0·51, 0·36 to 0·71; P < 0·001), intra-abdominal fluid collection ( OR 0·50, 0·34 to 0·74; P < 0·001) and biliary fistula ( OR 0·42, 0·18 to 0·93; P = 0·03) than PJ. Conclusion Meta-analysis of four RCTs based on ISGPF criteria, and seven RCTs using non-standard criteria, revealed that PG reduced the incidence of POPF after PD compared with PJ. [ABSTRACT FROM AUTHOR]