SynthesisInternational journal of colorectal disease2026
The effectiveness and safety of isoperistaltic versus antiperistaltic side-to-side ileocolic anastomosis in minimally invasive radical right hemicolectomy: a systematic review and meta-analysis.
Synthesis in International journal of colorectal disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
background and purposeTwo main side-to-side anastomosis techniques are used in minimally invasive radical right hemicolectomy: the traditional antiperistaltic (ANTI) and the more recently adopted isoperistaltic (ISO) overlap method. Their comparative clinical efficacy remains controversial. This study aimed to evaluate the effectiveness and safety of ISO versus ANTI for ileocolic anastomosis, providing evidence-based guidance for surgical technique selection.
methodsWe systematically searched CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, Web of Science, and Cochrane Library from database inception to January 2026 for studies comparing ANTI and ISO. Cohort study quality was assessed using the Newcastle-Ottawa Scale, and randomized controlled trials (RCTs) were assessed using the Cochrane tools. Meta-analysis, sensitivity analysis, and publication bias evaluation were performed using RevMan 5.3 and STATA 17.
resultsSix studies (5 cohorts, 1 RCTs) comprising 931 patients were included. The meta-analysis indicated that the incidence of bowel obstruction was higher in the ANTI group than in the ISO group, with a borderline significant difference [RR = 1.75, 95% CI (1.01, 3.05), P = 0.05], and the ANTI group required a longer anastomosis time [MD = 1.03, 95% CI (0.35, 1.71), P = 0.003]. No significant differences were found between the two techniques regarding anastomotic leakage, anastomotic bleeding, time to first flatus, time to first defecation, readmission rate, surgery-related mortality, intra-abdominal infection, wound infection, chronic diarrhea, operative time, hospital stay, intraoperative blood loss, or time to first oral intake (all P > 0.05). Sensitivity analysis revealed significantly longer total operative time for ANTI [MD = 8.75, 95% CI (6.11, 11.39), P < 0.00001]. No reversal occurred in the results for other outcomes, indicating robust findings in this study. Publication bias risk analysis showed that publication bias was unlikely in this study.
conclusionsBoth anastomotic methods are effective and safe in minimally invasive radical right hemicolectomy. The ISO may offer modest technical advantages, but current evidence does not justify a strong preferential recommendation.
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