Postoperative pancreatic fistula after pancreaticogastrostomy versus pancreatojejunostomy after pancreatic resection, a comparative systematic review and meta-analysis.

Autor: Salman MA; General Surgery Department, Kasralainy School of Medicine, Cairo University, Giza, Egypt., Elewa A; General Surgery Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt., Elsherbiny M; General Surgery Department, United Lincolnshire NHS Trust, Lincoln, UK., Tourkey M; General Surgery Department, Great Western Hospital, Swindon, UK., Emechap EN; General Surgery Department, Great Western Hospital, Swindon, UK., Chikukuza S; General Surgery Department, Great Western Hospital, Swindon, UK., Salman A; Internal Medicine Department, Kasralainy School of Medicine, Cairo University, Giza, Egypt.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2024 Jun; Vol. 48 (6), pp. 1467-1480. Date of Electronic Publication: 2024 Apr 17.
DOI: 10.1002/wjs.12173
Abstrakt: Background: In patients undergoing pancreaticoduodenectomy (PD), there has been some evidence favoring pancreaticogastrostomy (PG) over pancreatojejunostomy (PJ) in the occurrence of postoperative pancreatic fistulas (POPF) and considering PG as a safer anastomotic technique. However, other publications revealed comparable incidences of POPF attributed to both techniques. The current work attempts to reach a more consolidated conclusion about such an issue.
Methods: This is a systematic review and meta-analysis that analyzed the studies comparing PG and PJ during PD in terms of the rate of POPF occurrence. Studies were obtained by searching the Scopus, PubMed Central, and Cochrane Central Register of Controlled Trials databases.
Results: 35 articles published between 1995 and 2022 presented data from 14,666 patients; 4547 underwent PG and 10,119 underwent PJ. Statistically significant lower rates of POPF (p = 0.044) and clinically relevant CR-POPF (p = 0.043) were shown in the PG group. The post-pancreatectomy hemorrhage (PPH) was significantly higher in the PG group, while no significant difference was found between the two groups in the clinically significant PPH. No statistically significant differences were found regarding the amount of intraoperative blood loss, length of hospital stay, DGE, overall morbidity rates, reoperation rates, or mortality rates. The percentage of male sex in the PG group and the percentage of soft pancreas in the PJ group seem to influence the odds ratio of CR-POPF (p = 0.076 and 0.074, respectively).
Conclusion: The present study emphasizes the superiority of PG over PJ regarding CR-POPF rates. Higher rates of postoperative hemorrhage were associated with PG. Yet, the clinically significant hemorrhage rate was comparable between the two groups.
(© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
Databáze: MEDLINE
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