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Pancreaticogastrostomy versus pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials

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Abstract

Purpose

We conducted this meta-analysis to establish whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better method of reconstruction for reducing the risk of postoperative pancreatic fistula (POPF).

Methods

This study involved a systematic article search and review of published randomized controlled trials (RCTs) comparing PG vs. PJ after pancreaticoduodenectomy (PD). Cochrane’s risk of bias-assessing tool was used to assess the quality of included studies. The fixed-effect model, random-effect model, and subgroup analysis were performed for the sensitivity analysis.

Results

Six RCTs reporting data on 998 patients were included. The incidence of POPF was lower in the PG group (risk ratio, RR = 0.65, 95 % CI 0.43–0.97, P = 0.03), but there was no significant difference in delayed gastric emptying, intra-abdominal fluid collection, biliary fistula, wound infection, postpancreatectomy hemorrhage, overall postoperative complication, or postoperative mortality between the procedures.

Conclusions

This meta-analysis shows that PG is superior to PJ for reducing the incidence of POPF, but there were no differences in other complications or mortality. Therefore, it may be considered as an alternative to PJ and further RCTs are needed to prove our findings.

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Acknowledgments

We thank HF. Wang and XY. Xia, Department of Library, Dalian Medical University, Dalian, China, for advice on the literature search. This study was funded by the Specialized Research Fund for the Doctoral Program of Higher Education (No. 20122105110009) and the China National Natural Science Foundation (No.81473504, No. 81200989).

Conflict of interest

None of the authors obtained any financial support from any organizations or companies in relation to this research.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, 116011, Dalian, Liaoning, China

    Xianbin Zhang, Haidong Bao, Peng Liu, Ahsen- Aziz, Zhongyu Wang & Peng Gong

  2. Department of Epidemiology, Dalian Medical University, Dalian, Liaoning, China

    Li Ma & Xiaohong Gao

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  1. Xianbin Zhang
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  2. Li Ma
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Correspondence to Peng Gong.

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Zhang, X., Ma, L., Gao, X. et al. Pancreaticogastrostomy versus pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Surg Today 45, 585–594 (2015). https://doi.org/10.1007/s00595-014-1030-1

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