Journal of Gastrointestinal Surgery

, Volume 18, Issue 9, pp 1693–1704 | Cite as

Pancreaticogastrostomy Versus Pancreaticojejunostomy After Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

  • Michael Clerveus
  • Antonio Morandeira-Rivas
  • Joaquín Picazo-Yeste
  • Carlos Moreno-Sanz
Review Article

Abstract

Background

The aim of this systematic review was to compare postoperative outcomes between pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy.

Methods

Six databases were systematically reviewed to identify randomized controlled trials comparing pancreaticogastrostomy and pancreaticojejunostomy. Studies reporting postoperative complications, reoperations, and mortality were included (PROSPERO registration number CRD42013005383).

Results

The search provided a total of 1,646 references. Seven studies were selected including 1,121 patients, 562 in the pancreaticogastrostomy group and 559 in the pancreaticojejunostomy group. Overall incidence of pancreatic fistula and the incidence of more severe fistulas (grade B/C) were lower in the pancreaticogastrostomy group (relative risk 0.67; 95 % confidence interval (CI) 0.52 to 0.86; p = 0.002 and relative risk 0.61; 95 % CI 0.40 to 0.93; p = 0.02). Abdominal collections were more frequent in the pancreaticojejunostomy group. However, pancreaticogastrostomy was associated with an increased risk of postoperative intraluminal hemorrhage, and there were no differences in overall morbidity, reoperations, or mortality.

Conclusions

In this systematic review and meta-analysis, a reduction in the incidence of postoperative pancreatic fistula in the pancreaticogastrostomy group was observed. Although this evidence comes from randomized trials, pancreaticogastrostomy cannot be considered superior to pancreaticojejunostomy due to the presence of clinical heterogeneity among studies and the absence of differences in overall morbidity, reoperations, and mortality.

Keywords

Pancreaticogastrostomy Pancreaticojejunostomy Pancreatic fistula Pancreaticoduodenectomy 

Notes

Acknowledgments

The authors would like to thank the staff of the Research Support Unit at the Mancha Centro General Hospital for their valuable comments and suggestions.

Conflict of Interest

Nothing to disclose.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Michael Clerveus
    • 1
  • Antonio Morandeira-Rivas
    • 1
  • Joaquín Picazo-Yeste
    • 1
  • Carlos Moreno-Sanz
    • 1
  1. 1.Department of Surgery“Mancha Centro” General HospitalCiudad RealSpain

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