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External Stent Versus No Stent for Pancreaticojejunostomy: A Meta-analysis of Randomized Controlled Trials.
MedLine Citation:
PMID:  23568149     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The effectiveness of an external pancreatic duct stent for reduction of the pancreatic fistula after pancreaticoduodenectomy remains controversial. METHODS: MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were searched for eligible randomized controlled trials (RCTs). Reviews of each trial were conducted and data were extracted. The primary outcome was pancreatic fistula. Statistical pooling used the fixed or random effects model and reported as risk ratio (RR) or mean difference (MD) with the corresponding 95 % confidence intervals (CI). RESULTS: Four RCTs including a total of 416 patients were detected. Methodological quality assessment revealed a better quality of all analyzed trials. Placing an external stent across pancreaticojejunal anastomosis could significantly reduce the incidence of pancreatic fistula (RR = 0.57, 95 % CI = 0.41-0.80, P = 0.001, I (2) = 0 %), overall morbidity (RR = 0.79, 95 % CI = 0.64-0.98, P = 0.03), and the length of hospital stay (MD = -3.98 days, 95 % CI = -6.42 to -1.54, P = 0.001, I (2) = 13 %). No significant difference was found in terms of hospital mortality, delayed gastric emptying, operation time, operative blood loss, blood replacement, and reoperation rate. CONCLUSIONS: This meta-analysis provides compelling evidence that the application of an external pancreatic duct stent after pancreaticoduodenectomy can decrease the incidence of pancreatic leakage when compared with no stent. Moreover, the external drainage of pancreatic juice is associated with lower postoperative overall morbidity and shorter hospital stay.
Authors:
Shukun Hong; Hongye Wang; Shiyong Yang; Kunxing Yang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-4-9
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  -     ISSN:  1873-4626     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-4-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of General Surgery, Nanjing Hospital Affiliated to Nanjing Medical University, 68# Changle Road, Nanjing, 210006, Jiangsu, China.
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