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Pancreaticogastrostomy Is Superior to Pancreaticojejunostomy for Prevention of Pancreatic Fistula After Pancreaticoduodenectomy: An Updated Meta-analysis of Randomized Controlled Trials

Menahem, Benjamin MD*; Guittet, Lydia MD, PhD; Mulliri, Andrea MD*; Alves, Arnaud MD, PhD*; Lubrano, Jean MD*

doi: 10.1097/SLA.0000000000000806
Meta-analysis

Objective: To review prospective randomized controlled trials to determine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is associated with lower risks of mortality and pancreatic fistula after pancreaticoduodenectomy (PD).

Background: Previous studies comparing reconstruction by PG and PJ reported conflicting results regarding the relative risks of mortality and pancreatic fistula after these procedures.

Methods: MEDLINE, the Cochrane Trials Register, and EMBASE were searched for prospective randomized controlled trials comparing PG and PJ after PD, published up to November 2013. Meta-analysis was performed using Review Manager 5.0.

Results: Seven trials were selected, including 562 patients who underwent PG and 559 who underwent PJ. The pancreatic fistula rate was significantly lower in the PG group than in the PJ group (63/562, 11.2% vs 84/559, 18.7%; odds ratio = 0.53; 95% confidence interval, 0.38–0.75; P = 0.0003). The overall mortality rate was 3.7% (18/489) in the PG group and 3.9% (19/487) in the PJ group (P = 0.68). The biliary fistula rate was significantly lower in the PG group than in the PJ group (8/400, 2.0% vs 19/392, 4.8%; odds ratio = 0.42; 95% confidence interval, 0.18–0.93; P = 0.03).

Conclusions: In PD, reconstruction by PG is associated with lower postoperative pancreatic and biliary fistula rates.

This updated meta-analysis found that pancreaticogastrostomy is superior to pancreaticojejunostomy for the prevention of pancreatic and biliary fistulas after pancreaticoduodenectomy.

*Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France

Cancers and Prevention Laboratory, Research Department, University Hospital of Caen INSERM U 1086, Centre François Baclesse, Caen Cedex, France.

Reprints: Benjamin Menahem, MD, Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14032 Caen Cedex, France. Email: menahem-b@chu-caen.fr.

Disclosure: The authors declare no conflicts of interest.

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