[Reconstruction methods of digestive tract after pancreaticodudenectomy: a systematic review and meta-analysis of RCTs]

Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Oct;17(10):1002-8.
[Article in Chinese]

Abstract

Objective: To investigate different types of anastomosis and reconstruction techniques after pancreaticodudenectomy with meat-analysis.

Methods: Systematically literature search was performed through Wanfang, PubMed, EMBASE, Web of Science and Cochrane Library database without restriction to regions, publication types, or languages. A total of 17 randomized controlled trials met the criteria and were evaluated by Jadad scale. Fixed and random-effects models were used to measure the pooled estimates, including pancreatic fistula, bile leakage, hemorrhage, delay gastric emptying(DGE), mortality, reoperation.

Results: Meta analysis revealed that patients undergoing pancreaticogastrostomy had a lower incidence of pancreatic fistula and bile leakage(OR=0.60, 95%CI:0.44-0.82, P=0.001; OR=0.33, 95%CI:0.13-0.82, P=0.02) as compared to pancreaticojejunostomy. In pancreaticoenterostomy group, pancreatic duct-mucosa pancreaticoenterostomy had no significant differences with traditional end-to-end anastomosis in terms of overall postoperative morbidity, and development of postoperative pancreatic fistula, reoperation, perioperative death. External stent placement drainage group had a lower postoperative overall complication rate and incidence of pancreatic fistula, especially the II(-III( grade pancreatic fistula, and a shorter hospital stay than non-stent drainage group(all P<0.05).

Conclusions: Pancreaticogastrostomy should be recommended as digestive tract reconstruction after pancreaticodudenectomy and assistant external stent drainage is also necessary.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anastomosis, Surgical
  • Drainage
  • Gastrointestinal Diseases / surgery*
  • Humans
  • Pancreas
  • Pancreaticojejunostomy
  • Plastic Surgery Procedures*
  • Postoperative Complications
  • Postoperative Period
  • Randomized Controlled Trials as Topic
  • Reoperation
  • Stents