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Meta-Analysis
. 2021 Jun;45(6):1929-1939.
doi: 10.1007/s00268-021-06039-x. Epub 2021 Mar 15.

Blumgart Anastomosis After Pancreaticoduodenectomy. A Comprehensive Systematic Review, Meta-Analysis, and Meta-Regression

Claudio Ricci  1   2 , Carlo Ingaldi  3   4 , Laura Alberici  3   4 , Nico Pagano  5 , Cristina Mosconi  6 , Giovanni Marasco  3   7 , Francesco Minni  3   4 , Riccardo Casadei  3   4
Affiliations
Meta-Analysis

Blumgart Anastomosis After Pancreaticoduodenectomy. A Comprehensive Systematic Review, Meta-Analysis, and Meta-Regression

Claudio Ricci et al. World J Surg. 2021 Jun.

Abstract

Background: The superiority of Blumgart anastomosis (BA) over non-BA duct to mucosa (non-BA DtoM) still remains under debate.

Methods: We performed a systematic search of studies comparing BA to non-BA DtoM. The primary endpoint was CR-POPF. Postoperative morbidity and mortality, post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), reoperation rate, and length of stay (LOS) were evaluated as secondary endpoints. The meta-analysis was carried out using random effect. The results were reported as odds ratio (OR), risk difference (RD), weighted mean difference (WMD), and number needed to treat (NNT).

Results: Twelve papers involving 2368 patients: 1075 BA and 1193 non-BA DtoM were included. Regarding the primary endpoint, BA was superior to non-BA DtoM (RD = 0.10; 95% CI: -0.16 to -0.04; NNT = 9). The multivariate ORs' meta-analysis confirmed BA's protective role (OR 0.26; 95% CI: 0.09 to 0.79). BA was superior to DtoM regarding overall morbidity (RD = -0.10; 95% CI: -0.18 to -0.02; NNT = 25), PPH (RD = -0.03; 95% CI -0.06 to -0.01; NNT = 33), and LOS (- 4.2 days; -7.1 to -1.2 95% CI).

Conclusion: BA seems to be superior to non-BA DtoM in avoiding CR-POPF.

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Conflict of interest statement

All authors declared that they did not have any conflict of interest.

Figures

Fig. 1
Fig. 1
Selection process
Fig. 2
Fig. 2
Forest plot for the primary endpoint. Legend ID = identification of the study (name of first authors and year of publication); RD risk difference; 95% CI: 95% confidence interval; BA   Blumgart anastomosis; non-BA = non-Blumgart duct to the mucosa. I2: heterogeneity; gray square: risk difference of each study; size of square: the weight of each study; solid black line: the 95% confidence interval; maroon diamond: the cumulative risk difference; dotted maroon line: the overall effect
Fig. 3
Fig. 3
Regression line of Egger test for publication bias assessment. Legend vertical axis: the measure of the effect divided by the standard error (SND); horizontal axis: the precision of each study (1/standard error); red line: regression line; blue circle: each included study; vertical red line: the intercept and its 95% confidence interval
See this image and copyright information in PMC

References

    1. Yin Z, Jin H, Jian Z. Half the truth is often a great lie: over a hundred years of controversy on pancreatic fistula between pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg. 2018;267:e52–e54. doi: 10.1097/SLA.0000000000002085. - DOI - PubMed
    1. Wang W, Zhang Z, Gu C, et al. The optimal choice for pancreatic anastomosis after pancreaticoduodenectomy: a network meta-analysis of randomized control trials. Int J Surg. 2018;57:111–116. doi: 10.1016/j.ijsu.2018.04.005. - DOI - PubMed
    1. Daamen LA, Smits FJ, Besselink MG, et al. A web-based overview, systematic review and meta-analysis of pancreatic anastomosis techniques following pancreatoduodenectomy. HPB (Oxford) 2018;20:777–785. doi: 10.1016/j.hpb.2018.03.003. - DOI - PubMed
    1. Pancreaticojejunostomy BM. In: Surgery of the liver and biliary tract. 3. Blumgart LH, Fong Y, editors. Philadelphia: Saunders; 2000. pp. 1073–1089.
    1. Kleespies A, Rentsch M, Seeliger H, et al. Blumgart anastomosis for pancreaticojejunostomy minimizes severe complications after pancreatic head resection. Br J Surg. 2009;96:741–750. doi: 10.1002/bjs.6634. - DOI - PubMed

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