Meta-analysis Of External Stent Versus No Stent For Pancreaticojejunostomy

ObjectiveTo systematically evaluate the postoperative pancreatic fistula rate、overall postoperativemorbidityrate、overallpostoperativemortalityrate、delayed gastric emptying rate and length of stay in external stent groupversus no stent group for pancreaticcoduodenectomy.MethodsArticles were searched in Pubmed, Cochrane library, Embase andCBM from May1990to May2013. Only randomized controlledtrails(RCTs) that compared the effectiveness of external stent versus nostent for pancreaticcoduodenectomy were included. The difference of inci-dence of postoperative pancreatic leakage，postoperative complications,hospitalization days and the postoperative mortality and incidence of post-operative gastric emptying disorder were analysised.ResultsA total of four trials with416cases comparing external stent with nostent were included,the external stent group with207patients and the nostent group with209patients. The meta-analysis revealed that, compared the external stent group with the no stent group, the rate of postoperativepancreatic fistula was significantly reduced in the external stent group［RR=0.57,95%CI（0.41，0.80）, P=0.001］, especially for the patinets ofpancreatic diameter≤3.0mm［RR=0.55,95%CI（0.37，0.82）, P=0.003］and soft pancreatic［RR=0.67,95%CI（0.45，0.99）, P=0.04］,the overallpostoperative morbidity rate of external stent group versus no stent groupwas reduced［RR=0.0.79,95%CI（0.64，0.98）, P=0.03］,and length of staywas shortened ［WMD=-3.98，95%CI（-6.42，-1.54）, P=0.001］.Therewas no difference between the two groups regarding the postoperative pan-creatic fistula rate of diameter＞3.0mm ［RR=0.37,95%CI（0.08，1.83）,P=0.22］，the overall postoperative mortality rate［RR=0.86,95%CI（0.28，2.65）, P=0.80］,and delayed gastric emptying rat［eRR=0.75,95%C（I0.24，2.35）, P=0.63］.Conclusion:Exental stent significantly reduced the postoperative pancreatic fistularate and overall postoperative morbidity rate、shortened the length of stay,and thus it is worth applying this method generally in clinical practice.