Pancreaticogastrostomy Versus Pancreaticojejunostomy After Pancreaticoduodenectomy: A Meta-analysis Of Complications

Objective:To evaluate and compare the clinical effectiveness of pancreatico gastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy.Methods: Through the following electronic database Cochrane、Pub Med、Medline 、 EMBASE 、 Science Direct 、 Springerlink CBM database 、 Chinese How Net, Wan Fang and VIP database literature and related articles by computer reference from 1994.1.1 to 2014.08.31.According to the inclusion and exclusion criteria, analysis after screening included in Meta RCT 13 documents,All literatures were evaluated and datas were extracted. The fistula pancreatic, biliary fistula,abdominal infection,delayed gastric emptying,hemorrhange,morbidity,overall mortality as observed indexes. Review Manager 5.2 was used for statistic analysis. Chi-square test was used for the statistical heterogeneity. Fixed effect model would used when P≥0.10 which means no statistical significance. Random effects model would used when P<0.10 which means statistical significance. Statistic analysis was based on all data of literatures and the forest map were drawed. Qualitative data use the odds ratio(OR) and 95% confidence interval(CI) and quantitative data use the mean difference(MD) and 95% confidence interval(CI) for statistical description,Publication bias was assessed by using a funnel plot. P < 0.05 was considered statistically significant。Results:1684 literatures were searched basing on standard, A total of thirteen randomized controlled trails literatures were chosen which included English ten and master’s degree thesis Chinese 3,The results of quality assessment showed the Thirteen studies were quality of excellent.Thirteen studys including 1870 patients, 904 in the pancreaticogastrostomy group and 966 in the pancreaticojejunostomy group, A Metaanalysis revealed that the incidence of pancreatic fistual was significantly lower in the PG group than in the PJ group OR: 0.57,95%CI :0.44 to 0.75,P<0.0001. the incidence of abdominal infection was lower in the PG group than in the PJ group(0.46 95%CI:0.32 to 0.66,P<0.0001),The incidence of biliary fistual was lower in the PG group than in the PJ group 0.47,95%CI:0.27 to 0.82, P﹦0.008, The incidence of Delayed gastric emptying was lower in the PG group than in the PJ group 1.22,95%CI:0.88 to 1.70,P﹦0.23.The incidence of Hemorrhage was lower in the PG group than in the PJ group 1.11, 95%CI:0.77 to 1.59,P﹦0.58, The incidence of Morbidity was lower in the PG group than in the PJ group 0.96,95%CI:0.76 to 1.20 P﹦0.70,The incidence of Overall mortality was lower in the PG group than in the PJ group 0.77. 95%CI:0.44 to 1.32,P﹦0.34.Conclusions: PG seemed to be superior to PJ in reducing the incidence of PF and abdominal infection and biliary fistula after PD. No significant differences were found between the PG and PJ groups in terms of delayed gastric hemorrhage, overall morbidity and mortality. But the results still need large sample, multi center prospective RCT study on verification.