Evaluation of the safety of two types of pancreatojejunostomy after pancreaticoduodenectomy

Abstract

Objective To evaluate the safety of duct-to-mucosa and invaginating pancreaticojejunostomy after pancreaticoduodenectomy. Methods Randomized controlled trials comparing duct-to-mucosa with invagination pancreaticojejunostomy following PD were searched, through Datebases CSCD, PubMed, The Cochrane Library, Web of Science and EMBASE, Outcome measures included postoperative pancreatic fistula, mortality, intra-abdominal collection, delayed gastric emptying, overall morbidity, postoperative hemorrhage and reoperation, the statistical analysis was done by RevMan5.3 soft ware. Results A total of 8 trials, 1 194 patients, were included in this Meta-analysis, No statistical difference were found in postoperative pancreatic fistula(OR=1.31, 95%CI: 0.95-1.79, P=0.10), Pancreatic fistula with soft texture of the pancreas (OR=1.64, 95%CI: 0.77-3.48, P=0.20), mortality(OR=1.02, 95%CI: 0.46-2.26, P=0.97) and postoperative hemorrhage (OR=1.13, 95%CI: 0.47-2.71, P=0.78) between duct-to-mucosa and invaginating pancreatojejunostomy. There were nor significant differences in overall morbidity, intra-abdominal collection, delayed gastric emptying and reoperation between the two groups. Conclusions The Meta-analysis based on 8 randomized controlled trials shows that the safety of the two reconstruction techniques is comparable. For soft texture of the pancreas, invaginated pancreatojejunostomy did not show a statistically significant superiority. Therefore, the surgeon should choose a reasonable reconstruction technique according to the results of the comprehensive evaluation of the patients. Key words: Pancreaticoduodenectomy; Pancreatojejunostomy; Pancreatic fistula; Meta-analysis