Stent placement for the prevention of clinically-relevant postoperative pancreatic fistula following pancreaticojejunostomy: A systematic review and meta-analysis.
Am J Surg
; 234: 122-128, 2024 Aug.
Article
en En
| MEDLINE
| ID: mdl-38594142
ABSTRACT
OBJECTIVES:
There remains a lack of consensus regarding the benefits of stent placement following pancreaticojejunostomy in terms of clinically relevant postoperative pancreatic fistulas (CR-POPFs). This study was aimed at analyzing the effects of stent placement, stent technique (internal and external), stent size, and dilation of the main pancreatic duct on CR-POPFs.METHODS:
Our study comprised a systematic review and meta-analysis of randomized controlled trials involving patients undergoing pancreaticojejunostomy. The primary outcome was defined as the incidence of CR-POPFs. Additionally, subgroup analyses were conducted, and pooled analyses were performed to provide comparative references.RESULTS:
Twelve randomized controlled trials, including a total of 1117 patients, were included. Compared with no stent placement, stenting did not exhibit a significant association with reduced CR-POPF incidence (odds ratio [OR] â= â0.60, 95% CI 0.34-1.04, P â= â0.07). Subgroup analysis revealed that only external stents, and not internal stents, were significantly associated with a reduced CR-POPF incidence compared with no stent placement (OR â= â0.53, 95% CI 0.28-0.99, P â= â0.05 vs. OR â= â0.92, 95% CI 0.28-3.05, P â= â0.89). Furthermore, stent placement in patients with a main pancreatic duct diameter of ≤3 âmm, and not in those with a main pancreatic duct diameter of >3 âmm, was associated with a significantly reduced CR-POPF incidence compared with no stent placement (OR â= â0.24, 95% CI 0.07-0.78, P â= â0.02 vs. OR â= â1.58, 95% CI 0.41-6.06, P â= â0.50).CONCLUSIONS:
The findings suggest a potential role for external stent placement in the prevention of CR-POPFs after pancreaticojejunostomy, particularly in patients with undilated pancreatic ducts. The reliability of our findings is constrained by the limited number of studies included. PROSPERO REGISTRATION NUMBER CRD42022380103.Palabras clave
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Base de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
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Pancreatoyeyunostomía
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Stents
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Fístula Pancreática
Límite:
Humans
Idioma:
En
Revista:
Am J Surg
Año:
2024
Tipo del documento:
Article
País de afiliación:
China