Comparison of the colonic J-pouch versus straight (end-to-end) anastomosis following low anterior resection: a systematic review and meta-analysis

Zaman, Shafquat; Mohamedahmed, Ali Yasen Y.; Ayeni, Adewale Adeoba; Peterknecht, Elizabeth; Mawji, Sadiq; Albendary, Mohamed; Mankotia, Rajnish; Akingboye, Akinfemi

doi:10.1007/s00384-022-04130-w

Cited by 12 publications

(6 citation statements)

References 68 publications

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“…Our recent comparative review of outcomes following straight (end-to-end) vs CJP anastomosis after low anterior resections found that the J-pouch was associated with a lower risk for anastomotic leak and re-operation. 35 Furthermore, better functional outcomes such as stool frequency were achieved using the CJP reconstruction over the straight anastomosis. 35 However, not all patients are considered suitable anatomically for creation of a J-pouch.…”

Section: Discussionmentioning

confidence: 99%

“…35 Furthermore, better functional outcomes such as stool frequency were achieved using the CJP reconstruction over the straight anastomosis. 35 However, not all patients are considered suitable anatomically for creation of a J-pouch. A modified technique such as a side-to-end configuration may help to address/overcome these challenges while maintaining functional advantages over the end-to-end anastomosis.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Colonic J-Pouch Versus Side-To-End Anastomosis Following Low Anterior Resection: A Systematic Review and Meta-Analysis

Zaman

Peterknecht

Bhattacharya

et al. 2023

The American Surgeon™

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Background The aim of this systematic review and meta-analysis is to evaluate clinical, functional, and anorectal physiology outcomes of the side-to-end vs colonic J-pouch (CJP) anastomosis following anterior resection for rectal cancer. Methods A PRISMA-compliant systematic review and meta-analysis was conducted using multiple electronic databases and clinical trial registers and all studies comparing side-to-end vs CJP anastomosis were included. Peri-operative complications, mortality rate, functional bowel, and anorectal outcomes were evaluated. Results Eight randomized controlled trials (RCTs) and two observational studies with 1125 patients (side-to-end: n = 557; CJP: n = 568) were included. Of the entire functional bowel outcome parameters analyzed, only the sensation of incomplete bowel evacuation was significant in the CJP group at 6 months [OR: 2.07; 95% CI 1.06 - 4.02, P = .03]. Peri- and post-operative clinical parameters were comparable in both groups (total operative time, intra-operative blood loss, anastomotic leak rate, return to theater, anastomotic stricture formation and mortality). Equally, most of the analyzed anorectal physiology parameters (anorectal volume, anal squeeze pressure, maximum anal volume) were not significantly different between the two groups. However, anal resting pressure (mmHg) 2 years post-operatively was noted to be significantly higher in the side-to-end group than that of the CJP configuration [MD: −8.76; 95% CI - 15.91 - 1.61, P = .02]. Discussion Clinical and functional outcomes following CJP surgery and side-to-end coloanal anastomosis are comparable. Neither technique appears to proffer solution to low anterior resection syndrome in the short term but future well-designed; high-quality RCTs with long term follow-up are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of the Colonic J-Pouch Versus Side-To-End Anastomosis Following Low Anterior Resection: A Systematic Review and Meta-Analysis

Zaman

Peterknecht

Bhattacharya

et al. 2023

The American Surgeon™

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“…Both Baker SEA and J-pouch have improved functional outcomes with decreased stool frequency and decreased need for antidiarrheal medication when compared with straight EEA. 10 Additionally, both SEA and CJPAA have been shown to have a lower anastomotic leak rate. 11 However, both require 3 to 5 cm more colonic mobilization.…”

Section: Options For Coloanal Anastomosismentioning

confidence: 99%

Coloanal Anastomosis

Johnston

2022

Clin Colon Rectal Surg

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“…Randomized controlled trials have demonstrated that the J-pouch and the side-to-end anastomosis have comparable functional outcomes in terms of frequency, urgency, incontinence and incomplete defaecation at long-term (>18 months) follow-up [3][4][5][6]. Compared to the straight anastomosis, a superiority of the J-pouch and the sideto-end anastomosis have been shown up to 12-18 months postoperatively [4,5,7]. The hitherto best designed and powered trial has compared J-pouch, side-to-end and straight anastomosis with a follow-up of 24 months [8].…”

Section: Introductionmentioning

confidence: 99%

“…A Cochrane review and one meta-analysis of randomized trials have not shown significant differences in postoperative complications between any of the anastomotic strategies, and a recent large randomized controlled trial has not shown any reduction in anastomotic leakage after reconstruction with the Jpouch compared to straight anastomosis [4,5,9]. However, an up-to-date meta-analysis, including other type of studies than randomized trials, indicated a higher rate of anastomotic leakage in the straight group compared to the J-pouch group [7].…”

Section: Introductionmentioning

confidence: 99%

The impact of the anastomotic configuration on low anterior resection syndrome 3 years after total mesorectal excision for rectal cancer: a national cohort study

et al. 2023

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Aim: After low anterior resection, the bowel can be anastomosed in different ways. It is not clear which configuration is optimal from a functional and complication point of view.The primary aim was to investigate the impact of the anastomotic configuration on bowel function evaluated by the low anterior resection syndrome (LARS) score. Secondarily, the impact on postoperative complications was evaluated.Method: All patients who had undergone low anterior resection from 2015 to 2017 were identified in the Swedish Colorectal Cancer Registry. Three years after surgery, patients were sent an extensive questionnaire and were analysed based on anastomotic configuration ('J-pouch/side-to-end anastomosis' or 'straight anastomosis'). Inverse probability weighting by propensity score was used to adjust for confounding factors.Results: Among 892 patients, 574 (64%) responded, of whom 494 patients were analysed. After weighting, the anastomotic configuration had no significant impact on the LARS score (J-pouch/side-to-end OR 1.05, 95% confidence interval [CI] 0.82-1.34). The J-pouch/side-to-end anastomosis was significantly associated with overall postoperative complications (OR 1.43, 95% CI 1.06-1.95). No significant difference was seen regarding surgical complications (OR 1.14, 95% CI 0.78-1.66). Conclusion:This is the first study investigating the impact of the anastomotic configuration on long-term bowel function, evaluated by the LARS score, in an unselected national cohort. Our results suggested no benefit for J-pouch/side-to-end anastomosis on longterm bowel function and postoperative complication rates. The anastomotic strategy may be based upon the anatomical conditions of the patient and surgical preference.

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Comparison of the colonic J-pouch versus straight (end-to-end) anastomosis following low anterior resection: a systematic review and meta-analysis

Cited by 12 publications

References 68 publications

Comparison of the Colonic J-Pouch Versus Side-To-End Anastomosis Following Low Anterior Resection: A Systematic Review and Meta-Analysis

Comparison of the Colonic J-Pouch Versus Side-To-End Anastomosis Following Low Anterior Resection: A Systematic Review and Meta-Analysis

Coloanal Anastomosis

The impact of the anastomotic configuration on low anterior resection syndrome 3 years after total mesorectal excision for rectal cancer: a national cohort study

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