Pancreatogastrostomy versus Pancreatojejunostomy: An Up-to-Date Meta-Analysis of RCTs

Perivoliotis, Konstantinos; Sioka, Eleni; Tatsioni, Athina; Stefanidis, Ioannis; Zintzaras, Elias; Zacharoulis, Dimitrios

doi:10.1155/2017/7526494

Cited by 16 publications

(13 citation statements)

References 47 publications

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“…Some meta-analyses [26][27][28] have shown a reduced incidence of insufficiency of the PG compared to PJ. PJ has been shown to be more physiological, as reduced incidence of impaired glucose tolerance, steatorrhea, and atrophic changes of the remaining pancreas have been reported in patients with PJ compared to patients with PG [29][30][31]. Nevertheless, it is hypothesized to adhere to well established surgical techniques to achieve best performance.…”

Section: Discussionmentioning

confidence: 99%

Predicting postoperative pancreatic fistula in pancreatic head resections: which score fits all?

Adamu

Plodeck

Adam

et al. 2021

Langenbecks Arch Surg

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Purpose Postoperative pancreatic fistula (POPF) is a major complication of pancreatic surgery and can be fatal. Better stratification of patients into risk groups may help to select those who might benefit from strategies to prevent complications. The aim of this study was to validate ten prognostic scores in patients who underwent pancreatic head surgery. Methods A total of 364 patients were included in this study between September 2012 and August 2017. Ten risk scores were applied to this cohort. Univariate and multivariate analyses were performed considering all risk factors in the scores. Furthermore, the stratification of patients into risk categories was statistically tested. Results Nine of the scores (Ansorge et al., Braga et al., Callery et al., Graham et al., Kantor et al., Mungroop et al., Roberts et al., Yamamoto et al. and Wellner et al.) showed strong prognostic stratification for developing POPF (p < 0.001). There was no significant prognostic value for the Fujiwara et al. risk score. Histology, pancreatic duct diameter, intraabdominal fat thickness in computed tomography findings, body mass index, and C-reactive protein were independent prognostic factors on multivariate analysis. Conclusion Most risk scores tend to stratify patients correctly according to risk for POPF. Nevertheless, except for the fistula risk score (Callery et al.) and its alternative version (Mungroop et al.), many of the published risk scores are obscure even for the dedicated pancreatic surgeon in terms of their clinical practicability. There is a need for future studies to provide strategies for preventing POPF and managing patients with high-risk stigmata.

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Section: Discussionmentioning

confidence: 99%

Predicting postoperative pancreatic fistula in pancreatic head resections: which score fits all?

Adamu

Plodeck

Adam

et al. 2021

Langenbecks Arch Surg

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“…Additionally, a higher frequency of impaired glucose tolerance after PG has been reported compared to PJ during the follow-up period. Considering the function of the remnant pancreas, the use of only short-term results is not sufficient for comparison[34,49].…”

Section: Pancreaticoduodenectomymentioning

confidence: 99%

Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery

Kawaida¹,

Kono²,

Hosomura³

et al. 2019

WJG

139

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Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.

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“…Some studies comparing PJ with PG showed no difference between these methods. 16 – 18 However, others showed that fewer postoperative fistulas develop after PG. 19 – 21 Therefore, we performed an up-to-date meta-analysis of randomized controlled trials (RCTs) to summarize the currently available evidence on PG versus PJ according to the newest 2016 ISGPS criteria.…”

mentioning

confidence: 99%

Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-analysis of RCTs Applying the ISGPS (2016) Criteria

Lyu¹,

Cheng³

et al. 2018

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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The goal of our study was to compare the impact of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) on the incidence of complications after pancreaticoduodenectomy. A systematic search was performed using RevMan 5.3 software. A meta-analysis showed that PG was not superior to PJ in terms of postoperative pancreatic fistula (POPF). In multicenter randomized controlled trials, the incidence of POPF was lower in patients undergoing PG than in those undergoing PJ. However, PG was associated with an increased risk of postoperative intraluminal hemorrhage, but no significant difference was observed between 2-layer PG and PJ. No significant differences were found in the rate of overall delayed gastric emptying, biliary fistula, reoperation, mortality, and morbidity. PG and PJ have similar incidences of POPF, but PG could be slightly superior to PJ in multicenter trials. However, this analysis verifies that PG has a higher rate of postpancreatectomy hemorrhage. Of note, a 2-layer anastomosis could reduce the occurrence of postpancreatectomy hemorrhage.

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Pancreatogastrostomy versus Pancreatojejunostomy: An Up-to-Date Meta-Analysis of RCTs

Cited by 16 publications

References 47 publications

Predicting postoperative pancreatic fistula in pancreatic head resections: which score fits all?

Predicting postoperative pancreatic fistula in pancreatic head resections: which score fits all?

Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery

Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-analysis of RCTs Applying the ISGPS (2016) Criteria

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