Effect of reinforced duct-mucosa anastomosis technique on clinically relevant postoperative pancreatic fistula: A retrospective cohort study and complimentary meta-analysis

Backgrounds/Aims: To evaluate the effect of reinforced duct-mucosa anastomosis (REDMA) technique on clinically relevant postoperative pancreatic fistula (CR-POPF) in patients undergoing pancreaticoduodenectomy (PD).Methods: The STROCSS guideline and the PRISMA statement standards were followed to conduct a retrospective cohort study and a complementary meta-analysis, respectively.All consecutive adult patients who underwent REDMA, a composite reconstruction technique incorporating mesh reinforcement, glue fixation, and pancreatic duct stenting simultaneously, during PD for pancreatic ductal adenocarcinoma between January 2017 and June 2022 were included in the cohort study.Moreover, all studies in the literature with a sample size ≥ 10 patients undergoing mesh-reinforced pancreaticojejunostomy during PD were included for the meta-analysis.Results: A total of 1,013 patients from 10 studies, including the current cohort study, were included.The risk of CR-POPF after mesh-reinforced pancreaticojejunostomy was 6.5% (95% confidence interval [CI] 3.7-9.3).The mesh-reinforced technique resulted in a lower risk of CR-POPF compared to the conventional technique (odds ratio: 0.35, 95% CI 0.15-0.80,p = 0.01).Additionally, the mesh-reinforced technique was associated with a shorter length of hospital stay (11.90 vs. 20.07days, p = 0.0001).There were no significant differences between the two techniques regarding biliary leak (p = 0.879), delayed gastric emptying (p = 0.479), gastrointestinal bleeding (p = 0.614), intraabdominal bleeding (p = 0.999), intraabdominal collection (p = 0.053), wound infection (p = 0.078), reintervention (p = 0.165), and 30-day mortality (p = 0.285).Conclusions: REDMA seems to be promising in reducing the risk of clinically relevant POPF after PD.The available evidence is insufficient to draw definitive conclusions; however, it offers a strong foundation for generating hypotheses and conducting power analyses in future prospective and randomized controlled trials.