Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 21, 2012; 18(43): 6315-6323
Published online Nov 21, 2012. doi: 10.3748/wjg.v18.i43.6315
Does antecolic reconstruction for duodenojejunostomy improve delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? A systematic review and meta-analysis
An-Ping Su, Shuang-Shuang Cao, Yi Zhang, Zhao-Da Zhang, Wei-Ming Hu, Bo-Le Tian
An-Ping Su, Shuang-Shuang Cao, Yi Zhang, Zhao-Da Zhang, Wei-Ming Hu, Bo-Le Tian, Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Tian BL designed the study; Su AP, Cao SS and Zhang Y conducted the majority of study; Su AP wrote the manuscript; Cao SS and Zhang Y revised the manuscript; Zhang ZD and Hu WM offered suggestions for this work
Correspondence to: Bo-Le Tian, MD, Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. boletian@126.com
Telephone: +86-28-85422475 Fax: +86-28-85422475
Received: May 22, 2012
Revised: August 17, 2012
Accepted: August 26, 2012
Published online: November 21, 2012
Abstract

AIM: To evaluate whether antecolic reconstruction for duodenojejunostomy (DJ) can decrease delayed gastric emptying (DGE) rate after pylorus-preserving pancreaticoduodenectomy (PPPD) through literature review and meta-analysis.

METHODS: Articles published between January 1991 and April 2012 comparing antecolic and retrocolic reconstruction for DJ after PPPD were retrieved from the databases of MEDLINE (PubMed), EMBASE, OVID and Cochrane Library Central. The primary outcome of interest was DGE. Either fixed effects model or random effects model was used to assess the pooled effect based on the heterogeneity.

RESULTS: Five articles were identified for inclusion: two randomized controlled trials and three non-randomized controlled trials. The meta-analysis revealed that antecolic reconstruction for DJ after PPPD was associated with a statistically significant decrease in the incidence of DGE [odds ratio (OR), 0.06; 95% CI, 0.02-0.17; P < 0.00 001] and intra-operative blood loss [mean difference (MD), -317.68; 95% CI, -416.67 to -218.70; P < 0.00 001]. There was no significant difference between the groups of antecolic and retrocolic reconstruction in operative time (MD, 25.23; 95% CI, -14.37 to 64.83; P = 0.21), postoperative mortality, overall morbidity (OR, 0.54; 95% CI, 0.20-1.46; P = 0.22) and length of postoperative hospital stay (MD, -9.08; 95% CI, -21.28 to 3.11; P = 0.14).

CONCLUSION: Antecolic reconstruction for DJ can decrease the DGE rate after PPPD.

Keywords: Pylorus-preserving pancreaticoduodenectomy; Delayed gastric emptying; Antecolic reconstruction; Retrocolic reconstruction; Duodenojejunostomy