Elsevier

Pancreatology

Volume 11, Issue 3, September 2011, Pages 362-370
Pancreatology

Does External Pancreatic Duct Stent Decrease Pancreatic Fistula Rate after Pancreatic Resection? A Meta-Analysis

https://doi.org/10.1159/000330222Get rights and content

Abstract

Objectives: The use of an external pancreatic duct stent to prevent fistula formation of pancreatic anastomosis remains a matter of debate. This study is a meta-analysis of the available evidence. Methods: Articles published until the end of March 2011 comparing external stenting and non-stenting in pancreatic anastomosis were included. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model. Results: Six articles were identified for inclusion: 3 randomized controlled trials and 3 observational clinical studies. The meta-analysis revealed that the use of an external pancreatic duct stent was associated with a statistically significant reduction in overall postoperative morbidity (OR 0.56; 95% CI 0.39–0.81; p = 0.002), pancreatic fistula (OR 0.34; 95% CI 0.23-0.15; p<0.001), severity of pancreaticfistula (OR 0.70; 95% CI 0.32–1.57; p = 0.04), delayed gastric emptying (OR 0.44; 95% CI 0.25–0.80; p = 0.007), and length of hospital stay (WMD -3.95; 95% CI -6.38 to -1.52; p = 0.001). Conclusions:The current literature suggests that the use of an external pancreatic duct stent reduced the leakage rate of pancreatic anastomosis after pancreatic resection.

References (40)

  • JS Park et al.

    Clinical validation and risk factors for delayed gastric emptying based on the International Study Group of Pancreatic Surgery (ISGPS) Classification

    Surgery

    (2009)
  • G Malleo et al.

    Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors

    HPB (Oxford)

    (2010)
  • RT Poon et al.

    Decreasing the pancreatic leak rate after pancreaticoduodenectomy

    Adv Surg

    (2008)
  • A Kleespies et al.

    The challenge of pancreatic anastomosis

    Langenbecks Arch Surg

    (2008)
  • S Ohwada et al.

    In situ vs. ex situ pancreatic duct stents of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy with billroth I-type reconstruction

    Arch Surg

    (2002)
  • G Batignani et al.

    Comparison of Wirsung-jejunal duct-to-mucosa and dunking technique for pancreatojejunostomy after pancreatoduodenectomy

    Hepatobiliary Pancreat Dis Int

    (2005)
  • R Hosotani et al.

    Duct-to-mucosa pancreaticojejunostomy reduces the risk of pancreatic leakage after pancreatoduodenectomy

    World J Surg

    (2002)
  • C Bassi et al.

    Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomyresults of a comparative study

    Ann Surg

    (2005)
  • A Maeda et al.

    Omental flap in pancreaticoduodenectomy for protection of splanchnic vessels

    World J Surg

    (2005)
  • M Kawai et al.

    Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients

    Ann Surg

    (2006)
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    1

    Bin Li, MS Department of Hepato-Biliary-Pancreato-Vascular Surgery First Affiliated Hospital of Xiamen University 55 Zhenhai Road, Xiamen 361003, Fujian Province (China) Tel. +86 592 213 9708

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