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A Systematic Review and Network-Meta-Analysis of Gastro-Enteric Reconstruction Techniques Following Pancreatoduodenectomy to Reduce Delayed Gastric Emptying

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Abstract

Introduction

This network meta-analysis aimed to identify the reconstruction technique associated with lowest rates of DGE following pancreatoduodenectomy (PD) from randomised controlled trials (RCTs).

Methods

A systematic literature search of PubMed, Embase and MEDLINE databases was carried out using the PRISMA framework to identify all RCTs comparing reconstruction techniques of gastrojejunostomy after PD, with overall DGE as the primary endpoint. The primary outcome measure was overall DGE. Secondary outcomes were grade B/C DGE, duration of nasogastric tube, time to solid food intake, overall and grade B/C pancreatic fistula, bile leaks, reoperation, length of hospital stay and in-hospital mortality.

Results

The search strategy identified eight RCTs including 761 patients. Six RCTs compared antecolic (n = 291 patients) and retrocolic Billroth II (n = 289 patients) reconstruction (n = 6 studies), and two RCTs compared antecolic Billroth II (n = 92 patients) and Roux-en-Y (n = 89 patients) reconstruction. Overall, antecolic Billroth II ranked best for overall and grade B/C DGE, bile leak, surgical site infection, length of stay and in-hospital mortality. Roux-en-Y was best for overall and grade B/C pancreatic fistula.

Conclusion

Antecolic Billroth II gastroenteric reconstruction is associated with the lowest rates of delayed gastric emptying after PD amongst the currently available techniques of gastrojejunostomy reconstructions.

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Authors and Affiliations

  1. Department of Hepatobiliary, Pancreatic and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK

    Sivesh K. Kamarajah, Giorgio Alessandri, Stuart M. Robinson, Colin H. Wilson, Jeremy J. French & Sanjay Pandanaboyana

  2. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK

    Sivesh K. Kamarajah

  3. College of Medical and Dental Sciences, University of Birmingham,, Birmingham, UK

    James R. Bundred

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  1. Sivesh K. Kamarajah
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All authors listed in this manuscript meet the authorship requirements set out by the International Committee of Medical Journal Editors (ICMJE).

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Correspondence to Sanjay Pandanaboyana.

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Critical Appraisal of Reconstruction Techniques following Pancreatoduodenectomy (PD) to Reduce Delayed Gastric Emptying: A Systematic review and Network Meta-Analysis. Sivesh Kamarajah, James Bundred, Rohan Thakkar, Stuart Robinson, Colin Wilson, Jeremy French, Sanjay Pandanaboyana. British journal of Surgery 2019; 109 (S7);25–26

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Kamarajah, S.K., Bundred, J.R., Alessandri, G. et al. A Systematic Review and Network-Meta-Analysis of Gastro-Enteric Reconstruction Techniques Following Pancreatoduodenectomy to Reduce Delayed Gastric Emptying. World J Surg 44, 2314–2322 (2020). https://doi.org/10.1007/s00268-020-05459-5

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