Related Paper Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI)
No differences in:
- surgical time – 130 mins [range 120–150] ISO vs. 140 mins [127–160] ANTI
- anastomotic time – 19 mins [17–22] ISO vs. 20 mins [16–25] ANTI
- postoperative complications – 37.0% ISO vs 40.7% ANTI
- postoperative ileus
- anastomotic leakage – 3.7% ISO vs. 5.56% ANTI
- in chronic diarrhoea rates in GIQLI scores – 24% ISO vs. 31.4% ANTI
Differences in favour of the antiperistaltic group were found in:
- Time to first flatus
- Time to first bowel movement
Anastomotic configuration did not influence hospital stay: 3 days [2–6] ISO vs. 3 [2–4] ANTI
Related Paper Isoperistaltic versus antiperistaltic stapled side-to-side anastomosis for colon cancer surgery: a randomized controlled trial
This RCT including 40 patients was suspended on detecting excess morbidity in the isoperistaltic stapled side-to-side anastomosis (SSSA) group
- Anastomotic leakage was seen in two patients in the isoperistaltic SSSA group, compared with none in the antiperistaltic SSSA group. Intraoperative findings demonstrated that rupture of the hand- sewn stapler entry hole was the site of the anastomotic leakage in both cases.
- No anastomotic haemorrhage was seen in either group.
- There was no significant difference in the median postoperative hospital stay (P = 0.313).
The authours conclued: “This study did not show any short-term advantage or disadvantage of isoperistaltic SSSA compared with that of antiperistaltic SSSA. However, considering that anastomotic leakage occurred only in the isoperistaltic SSSA group, additional modifications, such as applying a double layered, not a single layered sutured closure for the entry enterotomy for the linear stapler is recommended to perform safe isoperistaltic SSSA for colon surgery.”