Effect of antecolic versus retrocolic reconstruction for gastro/duodenojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: A meta‐analysis

Aim The aim of this meta‐analysis was to assess whether antecolic reconstruction is superior to retrocolic reconstruction for gastro/duodenojejunostomy with respect to delayed gastric emptying after pancreaticoduodenectomy. Patients and Methods A literature search of Medline ( PubMed ), EMBASE , OVID , EBSCO and the Cochrane database was done to identify randomized, controlled trials (RCT) comparing antecolic and retrocolic gastro/duodenojejunostomy after pancreaticoduodenectomy from J anuary 1991 to A pril 2012. Four RCT involving 189 patients, and comparing antecolic reconstruction with retrocolic reconstruction, were identified for inclusion. Results The meta‐analysis revealed that there was no significant difference between the two groups in terms of operation time [mean difference ( MD ): 4.39, 95 per cent confidence interval ( CI ): −19.51 to 28.28, P = 0.72], intraoperative blood loss ( MD : 22.51, 95 per cent CI : −160.56 to 205.58, P = 0.81), blood replacement ( MD : −0.19; 95 per cent CI : −0.62 to 0.23, P = 0.38), mortality [odds ratio ( OR ): 0.32, 95 per cent CI : 0.01–8.26, P = 0.49], morbidity ( OR : 2.25, 95 per cent CI : 0.57–8.82, P = 0.24), delayed gastric emptying ( OR : 0.31, 95 per cent CI : 0.08–1.26, P = 0.10) and length of postoperative hospital stay ( MD : −2.35, 95 per cent CI : −7.56 to 2.86, P = 0.38). Conclusion Compared to retrocolic reconstruction, antecolic reconstruction for gastro/duodenojejunostomy does not seem to offer an advantage with respect to delayed gastric emptying after pancreaticoduodenectomy.