Binding versus Conventional Pancreaticojejunostomy in Preventing Postoperative Pancreatic Fistula: A Systematic Review and Meta-Analysis

Abstract

Background: The aim of this study was to compare the safety and efficacy of a new technology, binding pancreaticojejunostomy (BPJ), with conventional pancreaticojejunostomy (CPJ) after pancreaticoduodenectomy in preventing postoperative pancreatic fistula (POPF).

Methods: Randomized controlled trials and observational studies were retrieved from literature searches. Pooled OR with 95% CI for dichotomous variables and weighted mean difference with 95% CI for continuous variables were calculated. Fixed-effect and random-effect models as well as subgroup analysis were used for sensitivity analysis.

Results: No statistically significant differences were found in the incidence of POPF, delayed gastric emptying, postpancreatectomy hemorrhage, reoperation, morbidity, mortality, operation time, intraoperative blood loss, blood transfusion, and hospital stay between 2 groups. However, the total costs of hospitalization and ordinary stay were higher in BPJ group (€10,513 ± €6,536 vs. €8,238 ± €4,687, p = 0.002; €7,946 ± €5,023 vs. €5,700 ± €2,902, p = 0.015, respectively).

Conclusions: Our study showed BPJ was as safe as CPJ. However, no significant superiority was found in BPJ group regarding the incidence of POPF. The total costs of hospital stay were higher for patients undergoing BPJ. Surgeons can prefer to perform the digestive tract reconstruction of their choice.

Keywords: Binding pancreaticojejunostomy; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative pancreatic fistula.