Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: critical analysis of prospective randomised trials

This is a critical analysis of prospective randomised trials that compare pancreatic reconstruction techniques with the stomach and the intestine, after pancreaticoduodenectomy. A questionnaire with questions from the Evidence Based Medicine Centre of Oxford University (PICO analysis) was used, following the criteria for the evaluation of randomised prospective studies for surgical interventions of the McMaster University in Ontario. It was found that the studies differed in methodological aspects, the most important being the lack of a uniform definition of a pancreatic fistula. The techniques for performing pancreaticogastrostomy and pancreaticojejunostomy were not homogeneous. There were no differences in the percentage of pancreatic fistula in three of these studies; one which modified the pancreaticogastrostomy technique had more favourable results. New comparative studies should use new definitions of the complications of pancreaticoduodenectomy and standardise the pancreatic reconstruction technique.