Pancreaticogastrostomy versus pancreaticojejunostomy

Abstract

Background: It has long been debated whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better choice for reconstruction after pancreaticoduodenectomy. The purpose of this study is to evaluate the two techniques.

Methods: Randomized controlled trials (RCTs) comparing PG with PJ published from January 1995 to January 2014 were searched electronically using PubMed, Medline, and Cochrane Library. Published data of these RCTs were analyzed using either fixed-effects model or random-effects model.

Results: Seven RCTs were included in this meta-analysis, with a total of 1121 patients (562 in PG, 559 in PJ). The incidence of postoperative pancreatic fistula and intra-abdominal fluid collection were significantly lower in PG than in PJ (respectively: odds ratio = 0.53 [0.37, 0.74], P < 0.001; odds ratio = 0.48 [0.30, 0.76], P < 0.01), no significant difference could be found for delayed gastric emptying, hemorrhage, morbidity, reoperation rate, and mortality.

Conclusions: The evidence from RCTs suggests that PG technique is associated with a lower rate of postoperative pancreatic fistula and intra-abdominal fluid collection than PJ.

Keywords: Meta-analysis; Pancreaticoduodenectomy; Pancreaticogastrostomy; Pancreaticojejunostomy.