Daily PubMed evidence board
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.
This systematic review and meta-analysis compared two ways surgeons reconnect bowel (isoperistaltic 'ISO' vs antiperistaltic 'ANTI') after minimally invas…
Signal score47Research triage score
CertaintyLowVerify in full text
PMID42234166Source identifier
Research triage, not medical advice
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Plain-English signal
This systematic review and meta-analysis compared two ways surgeons reconnect bowel (isoperistaltic 'ISO' vs antiperistaltic 'ANTI') after minimally invasive right hemicolectomy. Using six studies with 931 patients (five cohort studies and one randomized trial), the authors report that ISO was associated with a lower rate of postoperative bowel obstruction (borderline statistically significant) and a slightly shorter time to create the anastomosis. There were no clear differences in leakage, bleeding, infections, hospital stay, or most other measured outcomes. The authors conclude both methods are generally safe and effective, and ISO may offer modest technical advantages, but the current evidence does not support a strong recommendation to change practice without further confirmation.
Why it matters
- Addresses technique choice for ileocolic anastomosis during minimally invasive radical right hemicolectomy, a common oncologic colorectal procedure.
- Compares isoperistaltic (ISO) versus antiperistaltic (ANTI) side-to-side overlap anastomoses on clinically important surgical outcomes (bowel obstruction, anastomosis time, leakage, operative time).
- Findings may influence intraoperative technique selection, operating-room time allocation, and postoperative complication monitoring protocols for surgeons performing right hemicolectomy.
Primary outcomes
- Bowel obstruction
- Anastomosis time
- Anastomotic leakage
- Anastomotic bleeding
- Time to first flatus/defecation
Effect summary
Abstract-reported findings: ISO associated with lower incidence of bowel obstruction (RR 1.75 favoring ISO for fewer obstructions in abstract wording, borderline significance) and shorter anastomosis time (MD ~1.03 minutes shorter for ISO). Sensitivity analyses indicated longer total operative time for ANTI (MD ~8.75 minutes). No significant differences for leakage, bleeding, infections, return of bowel function, readmission, mortality, hospital stay, or blood loss.
Benefit-cost lens
| Quick take | Abstract-level evidence suggests ISO may modestly reduce bowel obstruction risk and shorten anastomosis time compared with ANTI, but overall safety and effectiveness are similar; economic/value claims require absolute baseline risks, local operating costs, and implementation assumptions. |
|---|---|
| BCR anchor | 1 |
| Time horizon | 3 |
| Discount rate | 0.03 |
| Assumptions | Derived from PubMed metadata and abstract only; full-text verification of study selection, heterogeneity, absolute event counts, and risk-of-bias assessments required before economic or policy conclusions. |
Benefit-cost fields are assumptions-based unless explicitly source-derived. Treat them as prompts for deeper economic review.
Risk of bias
| Tool | Gist from abstract: Newcastle-Ottawa Scale for cohorts; Cochrane tools for RCTs referenced |
|---|---|
| Verdict | Higher uncertainty |
| Notes | Assessment based on abstract only: pooled evidence includes mostly cohort studies (5/6) and a single RCT. Abstract does not report study-level risk-of-bias ratings, heterogeneity statistics in detail, or absolute event counts by study. Potential for selection bias and confounding in cohorts; limited randomized evidence reduces overall certainty. |
Harms, equity, conflicts & implementation
| Implementation | Before any implementation change: review full-text for detailed methods, verify absolute event counts and heterogeneity, consult colorectal surgery experts, assess training needs and OR workflow impact, and model local cost/benefit using absolute time and complication rates. |
|---|---|
| Equity impact | Unclear from abstract. Equity implications depend on whether one technique requires additional resources, specialized materials, or training that could limit access in resource-constrained settings; subgroup reporting (age, comorbidity, socioeconomic status) not described. |
| Harms | No clear increase in major harms reported in the abstract; anastomotic leakage, bleeding, infections, and mortality showed no significant differences. Full-text needed to verify absolute counts and less common adverse events. |
| Replication | Unknown from automated PubMed triage; follow-up replication not reported in abstract. |
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