ReviewPancreaticogastrostomy has advantages over pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy. A meta-analysis of randomized controlled trials

- A meta-analysis comparing pancreaticogastrostomy to pancreaticojejunostomy on pancreatic fistula is carried out.
- This is an up-to-date meta-analysis and included the largest sample size of 10 RCTs.
- Pancreaticogastrostomy is better in reducing pancreatic fistula and biliary fistula than pancreaticojejunostomy.

ObjectiveTo examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce postoperative complications, especially pancreatic fistula (PF), after pancreaticoduodenectomy (PD).BackgroundPF is a severe complication after PD. The best reconstructive method to reduce occurrence of PF is controversial. We carried out this meta-analysis to compare PG with PJ.MethodsA systematic review was conducted on PubMed, EMBASE, and Cochrane Library published up to October 2015 to identify studies comparing PG with PJ. Postoperative complications and mortality were evaluated. A meta-analysis was carried out by Review Manager 5.0.Results10 RCTs representing 1629 patients (826 PG, 803 PJ) were included. There was a significant difference in favor of PG over PJ (OR 0.72, 95% CI 0.56-0.92, P = 0.009, I2 = 10%). No significant differences were found in biliary fistula (OR 0.58, 95% CI 0.31-1.06, P = 0.08, I2 = 38%), DGE (OR 1.08, 95% CI 0.68-1.70, P = 0.75, I2 = 53%), overall morbidity (OR 0.97, 95% CI 0.77-1.23, P = 0.82, I2 = 28%), and mortality (OR 0.98, 95% CI 0.60-1.61, P = 0.94, I2 = 0%).ConclusionsThe meta-analysis showed a significant difference between PG and PJ on PF: PG was associated with significantly less PF when compared to PJ, indicating that PG is superior to PJ for reconstruction after PD.