Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jun;28(3):139-146.
doi: 10.1097/SLE.0000000000000530.

Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-analysis of RCTs Applying the ISGPS (2016) Criteria

Yunxiao Lyu  1 , Ting Li  2 , Yunxiao Cheng  1 , Bin Wang  1 , Liang Chen  1 , Sicong Zhao  1
Affiliations
Review

Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-analysis of RCTs Applying the ISGPS (2016) Criteria

Yunxiao Lyu et al. Surg Laparosc Endosc Percutan Tech. 2018 Jun.

Abstract

The goal of our study was to compare the impact of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) on the incidence of complications after pancreaticoduodenectomy. A systematic search was performed using RevMan 5.3 software. A meta-analysis showed that PG was not superior to PJ in terms of postoperative pancreatic fistula (POPF). In multicenter randomized controlled trials, the incidence of POPF was lower in patients undergoing PG than in those undergoing PJ. However, PG was associated with an increased risk of postoperative intraluminal hemorrhage, but no significant difference was observed between 2-layer PG and PJ. No significant differences were found in the rate of overall delayed gastric emptying, biliary fistula, reoperation, mortality, and morbidity. PG and PJ have similar incidences of POPF, but PG could be slightly superior to PJ in multicenter trials. However, this analysis verifies that PG has a higher rate of postpancreatectomy hemorrhage. Of note, a 2-layer anastomosis could reduce the occurrence of postpancreatectomy hemorrhage.

PubMed Disclaimer

Conflict of interest statement

The author(s) received no financial support for the research, authorship, and/or publication of this article. The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the published articles evaluated for inclusion in this meta-analysis.
FIGURE 2
FIGURE 2
Consensus risk of bias assessment of the included studies.
FIGURE 3
FIGURE 3
Forest plot of the meta-analysis comparing PG and PJ with regard to the incidence of POPF. CI indicates confidence interval; PG, pancreaticogastrostomy; PJ, pancreaticojejunostomy; POPF, postoperative pancreatic fistula.
FIGURE 4
FIGURE 4
Forest plot of the subgroup meta-analysis of the incidence of POPF according to the type of center (A and B); based on the type of PG (C and D); based on the type of PJ (E and F). CI indicates confidence interval; PG, pancreaticogastrostomy; PJ, pancreaticojejunostomy; POPF, postoperative pancreatic fistula.
FIGURE 5
FIGURE 5
Forest plot of the subgroup meta-analysis of the incidence of PPH (A); according to type of center (B and C); according to the type of PG (D and E). CI indicates confidence interval; PG, pancreaticogastrostomy; PJ, pancreaticojejunostomy; PPH, postpancreatectomy hemorrhage.
FIGURE 6
FIGURE 6
Forest plot of the subgroup meta-analysis of the incidence of DGE (A); bile fistula (B); mortality (C); morbidity (D) and reoperation (E). CI indicates confidence interval; DGE, delayed gastric emptying; PG, pancreaticogastrostomy; PJ, pancreaticojejunostomy.
See this image and copyright information in PMC

References

    1. Figueras J, Sabater L, Planellas P, et al. Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br J Surg. 2013;100:1597–1605. - PubMed
    1. Topal B, Fieuws S, Aerts R, et al. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol. 2013;14:655–662. - PubMed
    1. Addeo P, Delpero JR, Paye F, et al. Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association. HPB. 2014;16:46–55. - PMC - PubMed
    1. Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients. Surgery. 2006;139:591–598. - PubMed
    1. Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–1211. - PubMed