scholarly journals Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy on occurrences of postoperative pancreatic fistula after pancreaticoduodenectomy

2015 ◽  
Vol 38 (3) ◽  
pp. 155-160 ◽  
Author(s):  
Yanming Zhou ◽  
Jianhua Yu ◽  
Lupeng Wu ◽  
Bin Li
Keyword(s):  
Pancreatic Fistula ◽  
Meta Analysis ◽  
Postoperative Pancreatic Fistula

scholarly journals Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

2020 ◽  
Vol 405 (8) ◽  
pp. 1219-1231
Author(s):  
Sergio Pedrazzoli ◽  
Alessandra R. Brazzale
Keyword(s):  
Pancreatic Fistula ◽  
English Literature ◽  
Meta Analysis ◽  
Pool Analysis ◽  
Incidence Rates ◽  
Postoperative Pancreatic Fistula ◽  
Standard Management ◽  
Drain Removal ◽  
Number Of Patients ◽  
Related Mortality

Abstract Purpose Drains’ role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of “standard” and “draining-tract-targeted” management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF). Methods PubMed and Scopus were searched for “pancreaticoduodenectomy or pancreatoduodenectomy or duodenopancreatectomy,” “Whipple,” “proximal pancreatectomy,” “pylorus-preserving pancreatectomy,” and “postoperative pancreatic fistula or POPF.”. Main outcomes included clinically relevant (CR) POPF, grade-C POPF, overall mortality, POPF-related mortality, and CR-POPF-related mortality. Secondary outcomes were incidence of radiological and/or endoscopic interventions, reoperations, and completion pancreatectomies. Results Overall, 12,089 studies were retrieved by the search of the English literature (01/01/1990–31/12/2018). Three hundred and twenty-six studies (90,321 patients) reporting ≥ 100 PDs and ≥ 10 PD/year were finally included into the study. Average incidences were obtained by averaging the incidence rates reported in the single articles. Pooled incidences were calculated by combining the number of events and the total number of patients considered in the various studies. These were then meta-analyzed using DerSimonian and Laird’s (1986) method. Pearson’s chi-squared test was used to compare pooled incidences between groups. Post hoc testing was used to see which groups differed. The meta-analyzed incidences were compared using a fixed effect for moderators. “Draining-tract-targeted” management showed a significant advantage over “standard” management in four clinically relevant outcomes out of eight according to pool analysis and in one of them according to meta-analysis. Conclusion Clinically, “draining-targeted” management of POPF should be preferred to “standard” management.

scholarly journals Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

2020 ◽  
Author(s):  
lyu yunxiao ◽  
Bin Wang ◽  
Yunxiao Cheng ◽  
Yueming Xu ◽  
WeiBing Du
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Meta Analysis ◽  
Operation Time ◽  
Bile Leakage ◽  
Reoperation Rate ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Trials ◽  
Cochrane Central Register

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy.Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy.Conclusions This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

scholarly journals Binding versus Conventional Pancreaticojejunostomy in Preventing Postoperative Pancreatic Fistula: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 34 (4) ◽  
pp. 265-280 ◽  
Author(s):  
Xianbin Zhang ◽  
Xin Dong ◽  
Peng Liu ◽  
Yumei Yan ◽  
Yushan Wei ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Fistula ◽  
Meta Analysis ◽  
Postoperative Pancreatic Fistula

Article Commentary: Risk Factors of Pancreatic Fistula after Pancreaticoduodenectomy: A Collective Review

2011 ◽  
Vol 77 (3) ◽  
pp. 257-269 ◽  
Author(s):  
Giovanni Ramacciato ◽  
Paolo Mercantini ◽  
Niccolò Petrucciani ◽  
Giuseppe R. Nigri ◽  
Andrea Kazemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Technique ◽  
Length Of Stay ◽  
Pancreatic Fistula ◽  
Perioperative Management ◽  
Meta Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Diagnosis And Treatment ◽  
Current Evidence ◽  
The Ideal

Postoperative pancreatic fistula (POPF) is the most frequent complication after pancreaticoduodenectomy, results in increased morbidity and mortality, and adversely affects length of stay and costs. Reported rates of postoperative pancreatic fistula vary from 0 per cent up to more than 30 per cent. Plenty of randomized trails and meta-analysis were published to analyze the ideal procedure, technique of anastomosis, and perioperative management of patients undergoing pancreaticoduodenectomy; however, results are often discordant and clear evidence on the ideal management and surgical technique to reduce POPF rate is not yet provided. This collective review examined the current evidence about risk factors contributing to postoperative pancreatic fistula and delineates methods of diagnosis and treatment of this universally dreaded complication.

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