Effect of Billroth‐II versus Roux‐en‐Y reconstruction for gastrojejunostomy after pancreaticoduodenectomy on delayed gastric emptying: A meta‐analysis of randomized controlled trials

Abstract

Background/Purpose: Delayed gastric emptying (DGE) is one of the most common complications after pancreaticoduodenectomy (PD). The aim of the present metaanalysis was to evaluate the effect of Billroth-II(B-II) versus Roux-en-Y (R-Y) reconstruction for gastrojejunostomy on DGE after PD. Methods: A systematic literature search was performed using the electronic database MEDLINE (via PubMed and OVID), EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) of the Cochrane Library to select pertinent randomized controlled trials (RCTs) on this topic from January 1990 to January 2020.The primary outcome was identified as postoperative DGE. Subgroup analysis was established to compare the incidence of grade B and C DGE. Software Revman 5.3 was used for the statistical analysis, summary statistics were calculated using fixed effect model or random effect model. Results: Five RCTs including a total of 612 patients were eligible for this metaanalysis. The incidence of grade B and C DGE was significantly lower with the B-II reconstruction than with the R-Y reconstruction (8.0% vs. 14.8%, OR = 0.49, 95% CI: 0.26-0.95, P = 0.03) and the B-II reconstruction took a shorter operation time (WMD=−7.18, 95% CI: [−13.09, −1.27], P = 0,02). No statistically significant difference was found between the two reconstruction methods in terms of the incidence of postoperative pancreatic fistula (POPF), bile leak, intra-abdominal abscess, postoperative pneumonia and the length of postoperative hospital stay. Conclusions: B-II reconstruction after PD has a lower incidence of grade B and C DGE and shorter operation time compared with R-Y reconstruction.

Risk Factor Identification for Delayed Gastric Emptying after Distal Pancreatectomy—An Evaluation of 1688 Patients Based on the German StuDoQ|Pancreas Registry

“…Hormonal dysbalances after the resection of the duodenum, gastric ischemia and denervation due to the mobilization and lymphadenectomy are proposed causes for the occurrence of DGE after PD [ 18 ]. Furthermore, associations with reconstructional aspects (Billroth II vs. Roux en Y, antecolic vs. retrocolic) have been discussed [ 9 , 19 , 20 ]. These classical risk factors do not apply for DP procedures as the duodenum remains in situ.…”

“…A previous StuDoQ|Pancreas-based analysis of DGE following pancreaticoduodenectomy (PD) identified higher age, longer duration of surgery, reconstruction as pancreaticogastrostomy (PG), postoperative pancreatic fistula (POPF), insufficiency of the hepaticojejunostomy and other surgical complications as risk factors for the occurrence of DGE [ 2 ]. Additionally surgical techniques, sepsis or intraabdominal abscesses are discussed as risk factors for DGE in the literature [ 7 , 9 , 10 ]. As there is no known causal therapy, the prevention of DGE should be beneficial.…”

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

“…[54,55] The main purpose of Roux-en-Y reconstruction was to prevent retrograde biliary infection caused by bile reflux, premature activation of pancreatic enzymes, and bile reflux gastritis. However, based on the results of 4 RCTs and 10 observational studies, [50,52,56,57] no statistically significant differences were found between the two groups in any outcome indicators except operation time, which was longer for the patients undergoing Roux-en-Y reconstruction. These data could well explain the greater use of Billroth-II than Roux-en-Y in GJ reconstruction (74% vs 26%).…”

Gastric stasis following pancreatoduodenal resection: terminology and prevention issues

“…Несмотря на то что в значительной части публикаций исследовали реконструкцию Б2 и гастроеюноанастомоз по Ру после ПДР, патогенетического обоснования роли этих вариантов реконструкции в развитии гастростаза не обнаружили. В метаанализе, включившем 5 РКИ [32], был сделан вывод, что при идентичной частоте гастростаза в целом после реконструкции Б2 частота клинически значимого гастростаза была меньше. Однако стоит отметить, что этот метаанализ имеет ряд ограничений.…”