Background: Two methods of pancreatic duct decompression following pancreaticoduodenectomy (PD) are currently employed, the internal and external pancreatic duct stent. Previous analysis of the efficacy of ductal decompression following PD has been confounded by either including both the internal and external stent method or by small sample size. The aim of this meta-analysis was to analyze the efficacy of the external pancreatic duct stent method alone in preventing Post-Operative Pancreatic Fistula (POPF) formation and other complications in patients undergoing PD.
Methods: A systematic literature search was conducted using the Medline, Cochrane Library, SCI, and EMBASE databases on all studies published from January 1970 to March 2012 reporting the peri-operative outcomes following PD. The primary end-point was the incidence of POPF formation in the presence of external pancreatic duct stent placement. Secondary outcomes considered included the incidence of post-operative mortality, Delayed Gastric Emptying (DGE), postoperative wound infection, operative time and blood loss, and length of hospital stay.
Results: Four trials were included comprising 416 patients. There was a statistically significant decrease in the incidence of both any grade POPF formation (OR 0.37, 95% CI=0.23 to 0.58, P=0.0001) and clinically significant (grade B or C) POPF formation (OR 0.50, 95% CI=0.30 to 0.84, P=0.0009) in patients receiving an external pancreatic duct stent versus no stent following PD. Total length of hospital stay was also found to be shortened with the use of an external stent (SMD -0.39, 95% CI=-0.63 to -0.15, P=0.001).
Conclusions: There is a decreased incidence of POPF formation following PD in patients receiving an external pancreatic duct stent versus patients receiving no stent. Total length of hospital stay was also found to be favorably affected by placement of an external pancreatic duct stent.