• Stefano Crippa, Roberto Cirocchi, Justus Randolph, Stefano Partelli, Giulio Belfiori, Alessandra Piccioli, Amilcare Parisi, and Massimo Falconi.
• Department of Surgery, Division of Pancreatic Surgery, San Raffaele Scientific Institute, Vita e Salute University, Via Olgettina 60, 20132, Milan, Italy.
• Langenbecks Arch Surg. 2016 Jun 1; 401 (4): 427-37.

PurposeTo perform an up-to-date meta-analysis of randomized controlled trials (RCTs) comparing pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) in order to determine the safer anastomotic technique. Compared to existing meta-analysis, new RCTs were evaluated and subgroup analyses of different anastomotic techniques were carried out.MethodsWe conducted a bibliographic research using the National Library of Medicine's PubMed database from January 1990 to July 2015 of RCTs. Only RCTs, in English, that compared PG versus all types of PJ were selected. Data were independently extracted by two authors. We performed a quantitative systematic review following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A random-effect model was applied. Statistical heterogeneity was assessed using the I (2) and χ (2) tests. Primary outcomes were rate of overall and clinically significant pancreatic fistula (POPF).ResultsTen RCTs were identified including 1629 patients, 826 undergoing PG and 803 undergoing PJ. RCTs showed significant heterogeneity regarding definitions of POPF, perioperative management, and characteristics of pancreatic gland. No significant differences were found in the rate of overall and clinically significant POPF, morbidity, mortality, reoperation, and intra-abdominal sepsis when PG was compared with all types PJ or when subgroup analysis (double-layer PG with or without anterior gastrotomy versus duct to mucosa PJ and single-layer PG versus single-layer end-to-end/end-to-side PJ) were analyzed.ConclusionsPG is not superior to PJ in the prevention of POPF. Current RCTs have major methodological limitations with significant heterogeneity in regard to surgical techniques, definition of POPF/complications, and perioperative management.

18 keywords...

hide…