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

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 January 1991 to April 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.