Meta-analysis Of The Effect Of Gastrojejunostomy On Delayed Gastric Emptying In Pancreaticoduodenectomy

Purpose:Delayed gastric emptying is one of the common complications after pancreaticod uodenectomy.Anastomosis of the digestive tract during pancreaticoduodenectomy is considered to be one of the causes of delayed gastric emptying.Although systematic reviews have been performed to analyze the correlation between different anastomosis methods and delayed gastric emptying,but these Meta-analyses have fewer articles included.In recent years,there have been several related randomized controlled clinical studies.We have included these articles together to analyze whether the Roux-en-Y anastomosis of the pancreas and jejunum can increase the delay of gastric emptying compared with the Billroth ? anastomosis.Materials and Methods:A literature search was carried out to comparing postoperative complications of Billroth II versus Roux-en-Y reconstruction following PD published from 1 January2010 to 1 January 2020.We search online and review of literature in PubMed,Web of Science,EMBASE,Cochrane Library,Medline,CNKI and WanFang,etc.Two researchers completed literature screening according to the inclusion and exclusion criteria,evaluated the quality of the included literature,and independently extracted relevant data.Meta-analysis was performed using Rev Man 5.3 software.Based on the results of literature analysis heterogeneity tests,a fixed-effect model or a random-effect model was selected for Meta-analysis to produce a forest map,and a funnel chart was used to evaluate publication bias.Group analysis according to study type,randomized controlled study performed subgroup analysis based on gastric emptying delay grade and gallbladder anastomosis.Results:This study included 9 articles,of which 6 were randomized controlled trials and3 were retrospectively analyzed.A total of 1035 patients were included,including 481 patients with Roux-en-Y anastomosis and 554 patients with Billroth ? anastomosis.There was no significant difference in the effect of Roux-en-Y anastomosis andBillroth ? on delayed gastric emptying after pancreaticoduodenectomy(OR=0.76,95%[0.38,1.51],P=0.44),Subgroup analysis was performed according to the included literature research methods.Six randomized controlled trials showed no statistical difference between the two anastomosis methods(RR = 0.98,95% [0.68,1.41],P = 0.91),and three were retrospectively analyzed,the results were not statistically significant OR=0.41,95% [0.05,3.06],P=0.38.According to the definition and classification of gastric emptying delay(DGE)by the International Pancreatic Surgery Research Group(ISGPS),subgroup analysis of gastric emptying delay classification is performed.Grade A(RR = 0.72,95% [0.4,1.29],P = 0.27),Grade B-C(RR = 1.11,95%[0.79,1.56],P = 0.55),the difference in classification was not statistically significant;Subgroup analysis of gallbladder anastomosis showed no statistical difference.There was no significant difference in the effect of Roux-en-Y and Billroth? on pancreatic fistula(RR = 0.87,95% [0.69,1.15],P = 0.37),However,there was a statistically significant difference in operation time(MD=7.26,95%[1.33,13.20],P=0.02).Conclusions:Meta-analysis results showed that there was no significant difference in the effect of pancreaticoduodenal Roux-en-Y anastomosis and Billroth ? anastomosis on delayed gastric emptying during pancreaticoduodenectomy,However,the operation time of Roux-en-Y group was significantly longer than that of Billroth group.