valuable tools for future quality assessment and research in pancreatic surgery. P2-174. Preoperative fecal elastase-1 (FE-1) correlates with pancreatic fistula after major pancreatic resections Tommaso Giuliani 1 , Stefano Andrianello 1 , Cecilia Bortolato 1 , Giovanni Marchegiani 1 , Giulia De Marchi 2 , Antonio Amodio 2 , Luca Frulloni 2 , Giuseppe Malleo 1 , Roberto Salvia 1 , Claudio Bassi 1 1 Pancreas Institute, Pancreatic Surgery, Verona, Italy 2 Pancreas Institute, Gastroenterology, Verona, Italy Objectives Post-operative pancreatic fistula (POPF) is the major determinant of outcome after pancreatic resections. Validated predictors of POPF are usually assessed intraoperatively. The aim of the study is to evaluate the role of fecal elastase-1 (FE-1) as a predictor of POPF in the preoperative setting. Methods All the patients undergoing major pancreatic resections from April 2017 to February 2018 at the Pancreas Institute of the Verona Uni- versity were enrolled. FE-1 was tested preoperatively. Results From a total of 247 patients, 71 patients were eligible for the analysis. A ROC curve was plotted identifying 285mcg/g as the cut-off with 83% sensitivity and 50% specificity in predicting POPF (AUC 0.79). In case of pancreaticoduodenectomy (n¼ 46), patients with FE-1 < 285mcg/g more frequently presented with hard texture (68.4%, p< 0.05) and with a dilated duct (r2¼ 0.51, p< 0.01), showing also a reduced rate of POPF (10.5 vs. 37%, p< 0.05), post-operative acute pancreatitis (5.3 vs. 22.2%, p< 0.01) and abdominal abscesses (5.3 vs. 29.6%, p< 0.05). Considering only the patients with a soft pancreatic texture (n¼ 29), those with FE-1<285mcg/g still presented a lower rate of POPF (16.7 vs. 43.5%, p< 0.05). As for the patients undergoing distal pancreatectomy (n¼25), FE-1 was associated with post- operative complications too. In particular, no patients with FE-1<285mcg/ g developed a POPF (p<0.05) Conclusion In the hypothesis that the pancreatic exocrine function affects the development of POPF, this study demonstrates that preopera- tive FE-1 correlates with the rate of fistula after major pancreatic re- sections. Patients with a FE-1<285 mcg/g present a lower rate of POPF after both pancreaticoduodenectomy and distal pancreatectomy. FE-1 could be propose as an additional prognostic tool to increase the accuracy of the available risk scores. P2-175. How do different surgical reconstruction techniques affect the post- operative course of patients with pancreas head resections? - A sys- tematic review with meta-analysis Stephan Schorn, Ekin Ihsan Demir, Thomas Vogel, Daniel Reim, Rebekka Schirren, Dirk Wilhelm, Gueralp Onur Ceyhan, Helmut Friess Technische Universit€ at München, Department of Surgery, Munich, Germany Objectives Several surgical reconstruction techniques have been introduced to reduce the high rates of postoperative mortality and morbidity after pancreaticoduodenectomy/PD. These techniques include 1) the Child reconstruction defined as pancreatojejunostomy/PJ followed by hepaticojejunostomy/HJ and the gastrojejunostomy/GJ (“the standard/ s-Child”), 2) the s-Child reconstruction with an additional Braun enter- oenterostomy (“BE-Child"), or 3) Isolated-Roux-En-Y-pan- creaticojejunostomy (“Iso-Roux-En-Y”), in which the pancreas anastomosis is reconstructed in a separate loop after the GJ. However, the impact of these reconstruction methods on patients’ outcome has not been sufficiently compared in a systematic manner. Methods For this purpose, a systematic review and meta-analysis was designed according to the Preferred-Reporting-Items-for-Systematic-re- view-and-Meta-Analysis/PRISMA-guidelines. After screening Pubmed/ Medline, Scopus, Cochrane Library and Web-of-Science for relevant arti- cles meeting predefined inclusion and exclusion criteria, data were extracted and meta-analysis were performed calculating risk ratios/RR for postoperative complication between s-Child vs. BE-Child and s-Child vs. Iso-Roux-En-Y. Results Thereby,18 studies comparing BE-Child or Isolated-Roux-En-Y vs. s-Child could be identified. Whereas BE-Child (p¼0.44) nor Iso-Roux- En-Y (p¼0.54) displayed an impact on postoperative mortality, BE-Child displayed a decreased morbidity (p¼0.0002) compared to s-Child. BE- Child (p¼0.27) and Iso-Roux-En-Y (p¼0.29) did not affect postoperative pancreatic fistula/POPF in general but BE-strongly decreased the incidence of clinically relevant POPF (p<0.00001), clinically relevant delayed gastric emptying/DGE (p¼0.02), bile leaks (p<0.01) and hospital stay (p¼0.05) compared to s-Child. Moreover, BE-Child depicted also a slight decrease of DGE (p¼0.06), an increased operation time (p¼0.0002) with no impact on haemorrhage, surgical site infections and pulmonary complications. Conclusion BE-Child favourably affects the outcome of patients after PD. In contrast, no effect was visible for Iso-Roux-En-Y compared to S- Child. However, to underline these findings, a prospective randomized study is urgently needed. P2-176. Preoperative biliary stenting in patients with obstructive jaundice caused by the tumors of the pancreatoduodenal's area Magdalena Derejska 1 , Marek Durlik 1,2 1 Central Clinical Hospita of the Ministry of the Interior in Warsaw, Gastroenterological Surgery and Transplantation, Warsaw, Poland 2 Mossakowki Medical Research Centre Polish Academy of Sciences, Surgical Research and Transpalntology, Warsaw, Poland Objectives The procedure of excision of the head of the pancreas with the duodenum (the Whipple’s pancreatoduodenectomy) is an operation with a high risk of postoperative complications. Many patients with the tumors of pancreatoduodenal area develop obstructive jaundice as first symptom. It can be an additional risk factor of postoperative complica- tions. Biliary stenting is on purpose to improve the general condition of the patient before the surgical treatment, and thus reduce the number of perioperative morbidity and mortality. Methods In the years 10.2014-09-07 in the Department of Gastroen- terological Surgery and Transplantation 418 operations of excision of the head of the pancreas with the duodenum (the Whipple’s procedure) were performed due to pancreatic duodenal field tumors, including 146 (35%) patients after preoperative biliary stenting and in 85 (20%) with obstruc- tive jaundice operated without prior bile duct prosthesis. The effects of preoperative biliary stenting in patients with obstructive jaundice were evaluated by analysis of deaths and postoperative complications, espe- cially severe ones (grade III and IV on the Clavien-Dindo scale). Results The impact of the preoperative biliary stenting on reducing the number of postoperative complications has not been demonstrated. There was a statistically significant difference in the percentage of severe com- plications in the Clavien-Dindo scale (51% vs. 75%). In patients undergoing biliary stenting, there was a lower risk of bleedings (13% vs 40%), but a higher risk of infectious complications (27% vs 15%). The stenting of the common bile duct reduces the risk of death in patients with severe post- operative complications and a history of jaundice. However it delays a surgical treatment. The average time from biliary stenting to surgery was 10 weeks vs 3 weeks. Conclusion Routine biliary stenting in patients with obstructive jaundice before surgical treatment remains an unresolved issue. Based on Abstracts / Pancreatology 18 (2018) S1eS188 S76