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

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.