Preservation versus non-preservation of the duodenal passage following total gastrectomy: a systematic review.

backgroundVarious reconstruction procedures have been proposed for restoring the alimentary tract continuity after total gastrectomy. However, so far there is no consensus on the ideal post-gastrectomy reconstruction procedure. The necessity of preserving the duodenal passage is one of the major focuses of the debate concerning gastrointestinal reconstruction and is the objective of this study.

methodsA systematic literature search of PubMed, EMBASE, the Cochrane Library, SCI, and Chinese Biomedical Literature Database (CBM) was carried out before March 2012 to obtain studies of randomized controlled trials (RCT). Analysis was performed using RevMan 5.0 software.

resultsNine RCTs involving 642 participants met the selection criteria. The results of the meta-analyses showed that operative mortality and morbidity were not significantly different between the two procedures (preservation vs. non-preservation of duodenum). However, operative time was considerably prolonged by preserving the duodenal passage. Patients in the preservation group had an improved nutritional parameters (body weight, levels of serum iron and hemoglobin) in the short term (<6 months) after surgery. Beneficial effect on preventing postgastrectomy symptom (heartburn, dumping syndrome) was not found by maintaining the duodenal passage throughout a 2-year follow-up. Moreover, a qualitative measurement showed that no significant quality of life improvement for patients with a preserved duodenal passage.

conclusionThis systematic review failed to demonstrate obvious advantage in preserving duodenal passage after total gastrectomy.