Pancreaticogastrostomy has advantages over pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy. A meta-analysis of randomized controlled trials

Objective: To examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce postoperative complications, especially pancreatic fistula (PF), after pancreaticoduodenectomy (PD).

Background: PF is a severe complication after PD. The best reconstructive method to reduce occurrence of PF is controversial. We carried out this meta-analysis to compare PG with PJ.

Methods: A systematic review was conducted on PubMed, EMBASE, and Cochrane Library published up to October 2015 to identify studies comparing PG with PJ. Postoperative complications and mortality were evaluated. A meta-analysis was carried out by Review Manager 5.0.

Results: 10 RCTs representing 1629 patients (826 PG, 803 PJ) were included. There was a significant difference in favor of PG over PJ (OR 0.72, 95% CI 0.56-0.92, P = 0.009, I² = 10%). No significant differences were found in biliary fistula (OR 0.58, 95% CI 0.31-1.06, P = 0.08, I² = 38%), DGE (OR 1.08, 95% CI 0.68-1.70, P = 0.75, I² = 53%), overall morbidity (OR 0.97, 95% CI 0.77-1.23, P = 0.82, I² = 28%), and mortality (OR 0.98, 95% CI 0.60-1.61, P = 0.94, I² = 0%).

Conclusions: The meta-analysis showed a significant difference between PG and PJ on PF: PG was associated with significantly less PF when compared to PJ, indicating that PG is superior to PJ for reconstruction after PD.