Does antecolic reconstruction for duodenojejunostomy improve delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? A systematic review and meta-analysis  

作　　者：An-Ping Su Shuang-Shuang Cao Yi Zhang Zhao-Da Zhang Wei-Ming Hu Bo-Le Tian 

机构地区：[1]Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

出　　处：《World Journal of Gastroenterology》2012年第43期6315-6323,共9页世界胃肠病学杂志（英文版）

摘　　要：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.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.

关 键 词：Pylorus-preserving pancreaticoduodenectomy Delayed gastric emptying Antecolic reconstruction Retrocolic reconstruction DUODENOJEJUNOSTOMY 

分 类 号：S835.5[农业科学—畜牧学] S852.218[农业科学—畜牧兽医]