Impact of biodegradable stent on pancreatic leakage after pancreatoduodenectomy – systematic review

Purpose: Postoperative pancreatic fistula (POPF) is a serious complication following pancreatoduodenectomy, due to the risk of complications related to the leak. Intraoperative internal and external stenting of the pancreaticojejunostomy, have been used as a prophylactic measure with mixed results and with a risk of complications. Biodegradable stents could be a potential way to avoid complications associated with traditional stents and reduce the risk of pancreatic leaks and fistulas. Methods: A systematic review was conducted to investigate the effectiveness of biodegradable stents in reducing POPF after pancreatoduodenectomy. Studies using biodegradable stents and reporting the incidence of POPF were included. Reviews, case reports, and non-English studies were excluded. Results: Eight observational studies with a total of 155 patients were included. A meta-analysis was conducted, and the pooled incidence of POPF was around 7% (18 out 155 patients). Apart from one study (comparing biodegradable stent to regular stent), there were no comparator groups. Using ROBINS-I tool to assess the risk of bias, there was overall a moderate risk of bias. Conclusion: Biodegradable stents may be associated with lower risk of POPF. However, the observational design of the studies, the risk of bias and sample sizes, reduced the significance of the results. Well-designed randomized controlled trials are needed to assess the effectiveness.