Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: a systematic review and meta-analysis

Abstract

Background: We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy. Methods: We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software. Results: Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR = 0.36, 95% CI: 0.15-0.86, p = 0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD = 43.61, 95% CI: 21.64-65.58, P = 0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy. Conclusions: This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, highquality randomized controlled trials are required.

Pancreatico-Jejunostomy On Isolated Loop After Pancreatico-Duodenectomy: Is It Worthwhile?

“…The technique proposed by Aghalarov does not influence the rate of POPF, but reduced its severity, leading to less major morbidity and mortality. More recently, Lyu et al 26 reported a systematic review and meta-analysis comparing isolated PJ, isolated gastro-jejunostomy, and conventional PJ after PD. The results of this meta-analysis showed that isolated PJ was associated with a lower reoperation rate, but required longer operation time vs conventional PJ.…”

Comparative Study on the Incidence of Pancreatic Fistula and Biliary Fistula in Patients after Pancreaticoduodenectomy with Two Gastric Tube Placement Sites

“…Although there are many methods for the prevention and treatment of pancreatic fistula after pancreaticoduodenectomy, such as drug prevention, improvement of surgical methods and preoperative reduction of yellow, etc. [16][17][18][19][20][21], these methods cannot completely prevent the occurrence of pancreatic fistula and biliary fistula. Therefore, this study attempted to divide the patients into two groups, A and B, according to the different sites of gastric tube implantation.…”

Chirurgie periampullärer Pankreaskarzinome

“…Die Anastomosierung von Restpankreas, Gallengang und Magen/Duodenum an dieselbe Schlinge ist aufgrund der relativ einfachen Technik und basierend auf der aktuellen Datenlage als Standardrekonstruktion anzusehen [ 56 , 57 ]. So bringt die Durchführung von Pankreas- und Gallengangsanastomose in getrennt ausgeschalteten Schlingen keinen nachweisbaren Nutzen und ist aufgrund des größeren technischen und zeitlichen Aufwandes nicht zu empfehlen [ 58 ].…”