Document Detail

Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy.
MedLine Citation:
PMID:  16845693     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pancreaticoduodenectomy is the primary treatment for periampullary cancer. Associated morbidity is high and often related to pancreatic anastomotic failure. This paper compares rates of pancreatic fistula, morbidity and mortality after pancreaticoduodenectomy in patients having reconstruction by pancreaticogastrostomy with those in patients having reconstruction by pancreaticojejunostomy. METHODS: A meta-analysis was performed of all large cohort and randomized controlled trials carried out since 1990. RESULTS: Eleven articles were identified for inclusion: one prospective randomized trial, two non-randomized prospective trials and eight observational cohort studies. The meta-analysis revealed a higher rate of pancreatic fistula associated with pancreaticojejunostomy reconstruction (relative risk (RR) 2.62 (95 per cent confidence interval (c.i.) 1.91 to 3.60)). A higher overall morbidity rate was also demonstrated in this group (RR 1.43 (95 per cent c.i. 1.26 to 1.61)), as was a higher mortality rate (RR 2.51 (95 per cent c.i. 1.61 to 3.91)). CONCLUSION: Current literature suggests that the safer means of pancreatic reconstruction after pancreaticoduodenectomy is pancreaticogastrostomy, but much of the evidence comes from observational cohort study data.
A McKay; S Mackenzie; F R Sutherland; O F Bathe; C Doig; J Dort; C M Vollmer; E Dixon
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  The British journal of surgery     Volume:  93     ISSN:  0007-1323     ISO Abbreviation:  Br J Surg     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-24     Completed Date:  2006-09-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  929-36     Citation Subset:  AIM; IM    
Department of Surgery, University of Calgary, Calgary, Canada.
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MeSH Terms
Ampulla of Vater / surgery
Cohort Studies
Common Bile Duct Neoplasms / surgery*
Gastrostomy / methods*
Pancreatectomy / methods*
Pancreatic Fistula / etiology,  surgery*
Pancreaticoduodenectomy / adverse effects*
Pancreaticojejunostomy / methods*
Prospective Studies
Randomized Controlled Trials as Topic
Risk Factors
Comment In:
Br J Surg. 2006 Nov;93(11):1435   [PMID:  17058311 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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