Pompeu Bernardo F, Hoici Brunini Julia, Piassi Velucci Marília, Guedes Lucas, Leal Barone Gabriel, D Andrea Pigossi Beatriz, Mazzola Poli De Figueiredo Sérgio, Formiga Fernanda
General and Colorectal Surgery, University of São Caetano do Sul, São Paulo, BRA.
General Surgery, Hospital Heliópolis, São Paulo, BRA.
Cureus. 2025 Jun 9;17(6):e85603. doi: 10.7759/cureus.85603. eCollection 2025 Jun.
After right colectomy, ileocolic anastomoses can be configured as isoperistaltic (ISO) or antiperistaltic (ANTI), with the choice largely based on the surgeon's experience. This study aimed to evaluate these configurations regarding postoperative complications and operative outcomes. We searched PubMed, Scopus, and the Cochrane Central Register of Clinical Trials for studies published up to January 2025. Odds ratios (ORs) and mean differences (MDs), with 95% confidence intervals (CIs), were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and analyses were conducted with R Software version 4.4.1. Twelve studies involving patients undergoing colorectal surgery were included, comparing ISO and ANTI ileocolic anastomoses. ISO was associated with a significantly earlier return of flatus (MD: -0.3 days; 95% CI: -0.6 to -0.1; p<0.01). No statistically significant differences were found in anastomotic leak (OR: 0.61; 95% CI: 0.29-1.28; p=0.189), postoperative ileus (OR: 1.47; 95% CI: 0.87-2.50; p=0.149), anastomotic bleeding (OR: 0.70; 95% CI: 0.20-2.49; p=0.582), surgical site infection (SSI) (OR: 0.91; 95% CI: 0.38-2.17; p=0.829), reoperation (OR: 0.92; 95% CI: 0.47-1.82; p=0.813), time to first stool (MD: -0.3 days; 95% CI: -0.7 to 0.1; p=0.19), anastomotic time (MD: -0.2 minutes; 95% CI: -1.9 to 1.4; p=0.79), blood loss (MD: -4.0 mL; 95% CI: -17.8 to 9.8; p=0.57), operative time (MD: 4.2 minutes; 95% CI: -3.0 to 11.3; p=0.25), hospital stay (MD: -0.7 days; 95% CI: -1.7 to 0.4; p=0.19), or 30-day mortality (OR: 0.85; 95% CI: 0.25-2.86; p=0.787). Based on our findings, ISO and ANTI ileocolic anastomoses demonstrated comparable postoperative complication rates and operative outcomes. However, ISO was associated with a faster return of bowel function, evidenced by earlier passage of flatus.
右半结肠切除术后，回结肠吻合可采用顺蠕动（ISO）或逆蠕动（ANTI）方式，其选择很大程度上取决于外科医生的经验。本研究旨在评估这两种吻合方式的术后并发症及手术效果。我们检索了PubMed、Scopus和Cochrane临床试验中心注册库，查找截至2025年1月发表的研究。使用随机效应模型汇总比值比（OR）和平均差（MD）以及95%置信区间（CI）。使用I²统计量评估异质性，并使用R软件4.4.1版进行分析。纳入了12项涉及结直肠手术患者的研究，比较了ISO和ANTI回结肠吻合术。ISO与明显更早的排气恢复相关（MD：-0.3天；95%CI：-0.6至-0.1；p<0.01）。在吻合口漏（OR：0.61；95%CI：0.29 - 1.28；p = 0.189）、术后肠梗阻（OR：1.47；95%CI：0.87 - 2.50；p = 0.149）、吻合口出血（OR：0.70；95%CI：0.20 - 2.49；p = 0.582）、手术部位感染（SSI）（OR：0.91；95%CI：0.38 - 2.17；p = 0.829）、再次手术（OR：0.92；95%CI：0.47 - 1.82；p = 0.813）、首次排便时间（MD：-0.3天；95%CI：-0.7至0.1；p = 0.19）、吻合时间（MD：-0.2分钟；95%CI：-1.9至1.4；p = 0.79）、失血量（MD：-4.0 mL；95%CI：-17.8至9.8；p = 0.57）、手术时间（MD：4.2分钟；95%CI：-3.0至11.3；p = 0.25）、住院时间（MD：-0.7天；95%CI：-1.7至0.4；p = 0.19）或30天死亡率（OR：0.85；95%CI：0.25 - 2.86；p = 0.787）方面未发现统计学显著差异。根据我们的研究结果，ISO和ANTI回结肠吻合术显示出相当的术后并发症发生率和手术效果。然而，ISO与更快的肠道功能恢复相关，表现为更早排气。
