• Benjamin Menahem, Lydia Guittet, Andrea Mulliri, Arnaud Alves, and Jean Lubrano.
• *Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France †Cancers and Prevention Laboratory, Research Department, University Hospital of Caen INSERM U 1086, Centre François Baclesse, Caen Cedex, France.
• Ann. Surg. 2015 May 1; 261 (5): 882-7.

ObjectiveTo review prospective randomized controlled trials to determine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is associated with lower risks of mortality and pancreatic fistula after pancreaticoduodenectomy (PD).BackgroundPrevious studies comparing reconstruction by PG and PJ reported conflicting results regarding the relative risks of mortality and pancreatic fistula after these procedures.MethodsMEDLINE, the Cochrane Trials Register, and EMBASE were searched for prospective randomized controlled trials comparing PG and PJ after PD, published up to November 2013. Meta-analysis was performed using Review Manager 5.0.ResultsSeven trials were selected, including 562 patients who underwent PG and 559 who underwent PJ. The pancreatic fistula rate was significantly lower in the PG group than in the PJ group (63/562, 11.2% vs 84/559, 18.7%; odds ratio = 0.53; 95% confidence interval, 0.38-0.75; P = 0.0003). The overall mortality rate was 3.7% (18/489) in the PG group and 3.9% (19/487) in the PJ group (P = 0.68). The biliary fistula rate was significantly lower in the PG group than in the PJ group (8/400, 2.0% vs 19/392, 4.8%; odds ratio = 0.42; 95% confidence interval, 0.18-0.93; P = 0.03).ConclusionsIn PD, reconstruction by PG is associated with lower postoperative pancreatic and biliary fistula rates.

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