***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospect i ve and r and omized setting . Summary Background Data : While several techniques have been proposed for reconstructing pancreatico-digestive continuity , only a limited number of r and omized studies have been carried out . Methods : A total of 151 patients undergoing pancreaticoduodenectomy with soft residual tissue were r and omized to receive either pancreaticogastrostomy ( group PG ) or end-to-side pancreaticojejunostomy ( group PJ ) . Results : The 2 treatment groups showed no differences in vital statistics or underlying disease , mean duration of surgery , and need for intraoperative blood transfusion . Overall , the incidence of surgical complications was 34 % ( 29 % in PG , 39 % in PJ , P = not significant ) . Patients receiving PG showed a significantly lower rate of multiple surgical complications ( P = 0.002 ) . Pancreatic fistula was the most frequent complication , occurring in 14.5 % of patients ( 13 % in PG and 16 % in PJ , P = not significant ) . Five patients in each treatment arm required a second surgical intervention ; the postoperative mortality rate was 0.6 % . PG was favored over PJ due to significant differences in postoperative collection s ( P = 0.01 ) , delayed gastric emptying ( P = 0.03 ) , and biliary fistula ( P = 0.01 ) . The mean postoperative hospitalization period stay was comparable in both groups . Conclusions : When compared with PJ , PG did not show any significant differences in the overall postoperative complication rate or incidence of pancreatic fistula . However , biliary fistula , postoperative collection s and delayed gastric emptying are significantly reduced in patients treated by PG . In addition , pancreaticogastrostomy is associated with a significantly lower frequency of multiple surgical complications OBJECTIVE Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy . External drainage of pancreatic duct with a stent has been shown to reduce pancreatic fistula rate of pancreaticojejunostomy in a few retrospective or prospect i ve nonr and omized studies , but no r and omized controlled trial has been reported thus far . This single-center prospect i ve r and omized trial compared the results of pancreaticoduodenectomy with external drainage stent versus no stent for pancreaticojejunal anastomosis . METHODS A total of 120 patients undergoing pancreaticoduodenectomy with end-to-side pancreaticojejunal anastomosis were r and omized to have either an external stent inserted across the anastomosis to drain the pancreatic duct ( n = 60 ) or no stent ( n = 60 ) . Duct-to-mucosa anastomosis was performed in all cases . RESULTS The 2 groups were comparable in demographic data , underlying pathologies , pancreatic consistency , and duct diameter . Stented group had a significantly lower pancreatic fistula rate compared with nonstented group ( 6.7 % vs. 20 % , P = 0.032 ) . Radiologic or surgical intervention for pancreatic fistula was required in 1 patient in the stented group and 4 patients in the nonstented group . There were no significant differences in overall morbidity ( 31.7 % vs. 38.3 % , P = 0.444 ) and hospital mortality ( 1.7 % vs. 5 % , P = 0.309 ) . Two patients in the nonstented group and none in the stented group died of pancreatic fistula . Hospital stay was significantly shorter in the stented group ( mean 17 vs. 23 days , P = 0.039 ) . On multivariate analysis , no stenting and pancreatic duct diameter <3 mm were significant risk factors of pancreatic fistula . CONCLUSION External drainage of pancreatic duct with a stent reduced leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy The aim of this prospect i ve study was to clarify differences in postoperative changes of serum or drainage fluid pancreatic amylase levels and serum C-reactive protein ( CRP ) levels between patients with a soft pancreatic texture and those with a hard pancreatic texture undergoing pancreatoduodenectomy ( PD ) with pancreaticogastrostomy .  A total of 61 consecutive patients with resectable periampullary tumors undergoing PD were recruited . This population was divided into 27 patients with a hard pancreatic texture and 34 patients with a soft pancreatic texture .  Drainage fluid total amylase or pancreatic amylase levels , serum total amylase or pancreatic amylase levels , and serum CRP levels  were measured postoperatively . Clinicopathological data were also compared between two groups . Postoperative complications more frequently occurred in patients with a soft pancreatic texture compared with those with a hard pancreatic texture ( P = 0.029 ) . Serum or drainage fluid pancreatic amylase levels and serum CRP levels of patients with a soft pancreatic texture were significantly higher than those of patients with a hard pancreatic texture after PD on postoperative days 1 and 2 ( P < 0.05 ) . A soft pancreatic texture was identified as an only independent predictive factor of increased drainage fluid pancreatic amylase levels ( P = 0.006 ) and serum CRP levels ( P = 0.047 ) . A soft pancreatic texture is closely associated with increased drainage fluid pancreatic amylase and serum CRP levels after PD . More careful post-PD management is needed for patients with a soft pancreatic texture Pancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy ( PD ) with encouraging results in both retrospective and prospect i ve studies . We performed a prospect i ve r and omized trial to test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD . Two hundred thirty-eight patients were r and omized to either receive a pancreatic stent ( S ) or no stent ( NS ) , and stratified according to the texture of the pancreatic remnant ( soft/normal versus hard ) . Four patients were excluded from the study ; in three instances due to a pancreatic duct that was too small to cannulate and in the other instance because a total pancreatectomy was performed . Patients who r and omized to the S group had a 6-cm-long segment of a plastic pediatric feeding tube used to stent the pancreaticojejunostomy anastomosis . In patients with a soft pancreas , 57 r and omized to the S group and 56 r and omized to the NS group . In patients with a hard pancreas , 58 r and omized to the S group and 63 r and omized to the NS group . The S and NS groups for the entire study population , as well as for the subgroup of high-risk patients with soft pancreata , were similar as regard to demographics , past medical history , preoperative symptoms , preoperative procedures , and intraoperative data . The pancreatic fistula rate for the entire study population was 9.4 % . The fistula rates in the S and NS subgroups with hard pancreata were similar , at 1.7 % and 4.8 % ( P=0.4 ) , respectively . The fistula rates in the S and NS subgroups with soft pancreata were also similar , at 21.1 % and 10.7 % ( P=0.1 ) , respectively . A nonstatistically significant increase in the pancreatic fistula rate in the S group persisted after adjusting for the operating surgeon and technical details of the operation ( e.g. , anastomotic technique , anastomotic orientation , pancreatic duct size , and number of intra-abdominal drains placed ) . In patients with soft pancreata , 63 % percent of the pancreatic fistulas in stented patients required adjustment to the clinical pathway ( including two deaths ) , compared to 47 % of the pancreatic fistulas in patients in the NS group ( P=0.3 ) . Internal pancreatic duct stenting does not decrease the frequency or the severity of postoperative pancreatic fistulas Background The aim of this single-center r and omized trial was to compare the perioperative outcome of  pancreatoduodenectomy with pancreatogastrostomy ( PG ) vs pancreaticojejunostomy ( PJ ) . Methods R and omization was done intraoperatively . PG was performed via anterior and posterior gastrotomy with pursestring and inverting seromuscular suture ; control intervention was PJ with duct – mucosa anastomosis . The primary endpoint was postoperative pancreatic fistula ( POPF ) . Results From 2006 to 2011 , n = 268 patients were screened and n = 116 were r and omized to n = 59 PG and n = 57 PJ . There was no statistically significant difference regarding the primary endpoint ( PG vs PJ , 10 % vs 12 % , p = 0.775 ) . The subgroup of high-risk patients with a soft pancreas had a non-significantly lower pancreatic fistula rate with PG ( PG vs PJ , 14 vs 24 % , p = 0.352 ) . Analysis of secondary endpoints demonstrated a shorter operation time ( 404 vs 443 min , p = 0.005 ) and reduced hospital stay for PG ( 15 vs 17 days , p = 0.155 ) . Delayed gastric emptying ( DGE ; PG vs PJ , 27 vs 17 % , p = 0.246 ) and intraluminal bleeding ( PG vs PJ , 7 vs 2 % , p = 0.364 ) were more frequent with PG . Mortality was low in both groups ( < 2 % ) . Conclusions Our r and omized controlled trial shows no difference between PG and PJ as reconstruction techniques after partial pancreatoduodenectomy . POPF rate , DGE , and bleeding were not statistically different . Operation time was significantly shorter in the PG group Objective The authors hypothesized that pancreaticogastrostomy is safer than pancreaticojejunostomy after pancreaticoduodenectomy and less likely to be associated with a postoperative pancreatic fistula . Summary Background Data Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy , occurring in 10 % to 20 % of patients . Nonr and omized reports have suggested that pancreaticogastrostomy is less likely than pancreaticojejunostomy to be associated with postoperative complications . Methods Between May 1993 and January 1995 , the findings for 145 patients were analyzed in this prospect i ve trial at The Johns Hopkins Hospital . After giving their appropriate preoperative informed consent , patients were r and omly assigned to  pancreaticogastrostomy or pancreaticojejunostomy after completion of the pancreaticoduodenal resection .  All pancreatic anastomoses were performed in two layers without pancreatic duct stents and with closed suction drainage . Pancreatic fistula was defined as drainage of greater than 50 mL of amylase‐rich fluid on or after postoperative day 10 . Results The pancreaticogastrostomy ( n = 73 ) and pancreaticojejunostomy ( n = 72 ) groups were comparable with regard to multiple parameters , including demographics , medical history , preoperative laboratory values , and intraoperative factors , such as operative time , blood transfusions , pancreatic texture , length of pancreatic remnant mobilized , and pancreatic duct diameter . The overall incidence of pancreatic fistula after pancreaticoduodenectomy was 11.7 % ( 17/145 ) . The incidence of pancreatic fistula was similar for the pancreaticogastrostomy ( 12.3 % ) and pancreaticojejunostomy ( 11.1 % ) groups . Pancreatic fistula was associated with a significant prolongation of postoperative hospital stay ( 36 ± 5 vs. 15 ± 1 days ) ( p < 0.001 ) . Factors significantly increasing the risk of pancreatic fistula by univariate logistic regression analysis included ampullary or duodenal disease , soft pancreatic texture , longer operative time , greater intraoperative red blood cell transfusions , and lower surgical volume ( p < 0.05 ) . A multivariate logistic regression analysis revealed the factors most highly associated with pancreatic fistula to be lower surgical volume and ampullary or duodenal disease in the resected specimen . Conclusions Pancreatic fistula is a common complication after pancreaticoduodenectomy , with an incidence most strongly associated with surgical volume and underlying disease . These data do not support the hypothesis that pancreaticogastrostomy is safer than pancreaticojejunostomy or is associated with a lower incidence of pancreatic fistula BACKGROUND Anastomotic failure is still a significant problem that affects the outcome of pancreaticoduodenectomy . There have been many techniques proposed for the reconstruction of pancreatic digestive continuity , but there have been few prospect i ve and r and omized studies that compare their efficacy . METHODS In the current work , 144 patients who underwent a pancreaticoduodenectomy with soft residual tissue were assigned r and omly to receive either a duct-to-mucosa anastomosis ( group A ) or a 1-layer end-to-side pancreaticojejunostomy ( group B ) . RESULTS The 2 treatment groups were found not to have any differences in regards to vital statistics , underlying disease , or operative techniques . The postoper 
    Output:
    
This meta- analysis suggests that the most effective treatment for reconstruction of pancreatic continuity after pancreatoduodenectomy is pancreaticogastrostomy .