Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy—a systematic review with meta-analysis

摘要: Pancreaticoduodenectomy/PD is a technically demanding pancreatic resection. Options of surgical reconstruction include (1) the child defined as pancreatojejunostomy/PJ followed by hepaticojejunostomy/HJ and gastrojejunostomy/GJ “the standard/s-Child,” (2) s-child with an additional Braun enteroenterostomy “BE-Child,” or (3) Isolated-Roux-En-Y-pancreaticojejunostomy “Iso-Roux-En-Y,” in which pancreas anastomosis reconstructed separate loop after GJ. Yet, impact these methods on patients’ outcome has not been sufficiently compared systematic manner. A review meta-analysis were conducted according to Preferred-Reporting-Items-for-Systematic-review-and-Meta-Analysis/PRISMA-guidelines screening Pubmed/Medline, Scopus, Cochrane Library Web-of-Science. Articles meeting predefined criteria extracted was performed. Nineteen studies identified comparing BE-Child Isolated-Roux-En-Y vs. s-Child. Compared s-Child neither (p = 0.43) nor Iso-Roux-En-Y (p = 0.94) displayed postoperative mortality, whereas showed less complications (p = 0.02). (p = 0.15) (p = 0.61) did affect fistula/POPF general, but associated decrease clinically relevant POPF (p = 0.005), delayed gastric emptying/DGE B/C (p = 0.004), bile leaks (p = 0.01), hospital stay (p = 0.06). entailed also increased operation time (p = 0.0002) no DGE A/B/C, hemorrhage, site infections pulmonary complications. decreased risk for complications, particularly DGE, POPF, leaks, does seem clinical course PD. Therefore, BE seems be valuable method improve