Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI)

Ibáñez, Noelia; Abrisqueta, Jesús; Luján, Juan; Hernández, Quiteria; Rufete, María Dolores; Parrilla, Pascual

doi:10.1007/s00464-018-6580-7

Cited by 30 publications

(21 citation statements)

References 30 publications

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“…This concept is consistent with the theory of "functional pseudovalvular mechanism for antiperistaltic and colonic anastomosis." The antiperistaltic direction in ileocolic anastomosis may act like a functional pseudovalve reducing ileocecal reflux and postoperative ileus (13). The present study has some limitations.…”

Section: Discussionmentioning

confidence: 82%

“…This study presented that antiperistaltic anastomosis tends to be associated with a straight flow direction of gastrojejunostomy, reducing gastric food stasis. Similarly, a randomized controlled trial for ileocolic anastomosis after right hemicolectomy showed that patients with antiperistaltic anastomosis have a shorter intestinal transit time compared to those with isoperistaltic anastomosis (13).…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Clinical Outcomes Between Isoperistaltic and Antiperistaltic Anastomoses After Laparoscopic Distal Gastrectomy for Patients With Gastric Cancer

Lee

Kim

et al. 2020

Front. Oncol.

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Background: No consensus exists regarding the superiority of either of the two types of gastrointestinal anastomosis, which are isoperistaltic and antiperistaltic. This study aimed to compare the clinical outcomes between isoperistaltic and antiperistaltic anastomoses after total laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. Methods: We retrospectively reviewed the medical records of patients with gastric cancer who underwent TLDG with Billroth II anastomosis between January 2014 and December 2018. The patients were divided into two groups according to the peristaltic direction of gastrointestinal anastomosis after TLDG. One group underwent isoperistaltic anastomosis (Iso group), and the other underwent antiperistaltic anastomosis (Anti group). Clinical outcomes were compared between the groups. Results: Of the 148 patients who underwent TLDG with Billroth II anastomosis, 124 were included in the Iso group and 24 were included in the Anti group. The Anti and Iso groups showed no significant difference with regard to the incidence of internal hernia (0.0 vs. 6.5%, respectively; p = 0.355). The incidence of bile reflux was more frequent in the Iso group than in the Anti group (p = 0.010), but food stasis was more common in the Anti group than in the Iso group (p = 0.006). Conclusion: In gastric cancer patients who underwent TLDG in which postoperative adhesion was minimized, antiperistaltic anastomosis may have created a physiologic barrier in gastrointestinal continuity. However, a large-scale study is necessary to validate the relationship between the digestive stream and the peristaltic direction.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Comparison of the Clinical Outcomes Between Isoperistaltic and Antiperistaltic Anastomoses After Laparoscopic Distal Gastrectomy for Patients With Gastric Cancer

Lee

Kim

et al. 2020

Front. Oncol.

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“…Only two studies investigated the effect of an intervention on postoperative bowel function. One focused on different types of anastomosis formation [34], whilst another investigated the effect of probiotic administration [35].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The ISOVANTI trial [34] was a double-blind randomised trial comparing isoperistaltic with antiperistaltic ileocolic anastomoses in patients having laparoscopic right hemicolectomy for cancer. A total of 108 patients were included, with 54 randomised to each arm.…”

Section: Study Characteristicsmentioning

confidence: 99%

Systematic review: the effect of right hemicolectomy for cancer on postoperative bowel function

Hope

Reilly

Lund

et al. 2020

Support Care Cancer

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Background Right-sided cancer accounts for approximately 30% of bowel cancer in women and 22% in men. Colonic resection can cause changes in bowel function which affect daily activity. The aims are to assess the impact of right hemicolectomy for cancer on bowel function and to identify useful treatment modalities for managing bowel dysfunction after right hemicolectomy. Method The review was conducted in line with PRISMA. Eligible studies evaluated the impact of right hemicolectomy on bowel function in those treated for colorectal neoplasia or assessed the effect of surgical technique or other intervention on bowel function after right hemicolectomy. Right hemicolectomy for inflammatory bowel disease or benign cases only were excluded. Articles were limited to studies on human subjects written in English published between January 2008 and December 2018. Results The searches identified 7531 articles. Nine articles met the inclusion criteria, of which eight were cohort studies and one was a randomised trial. Loose stool, increased bowel frequency and/or nocturnal defaecation following right-sided colectomy occurs in approximately one in five patients. Some of these symptoms may improve spontaneously with time. Bile acid malabsorption and/or small bowel bacterial overgrowth may be the cause for chronic dysfunction. Some studies report that no or little difference in outcome between right-sided and rectal resections likely suggests poor function after right-sided resection. Conclusion Right hemicolectomy can result in changes to bowel function. Patients should be counselled preoperatively, and follow-up should be designed to identify and effectively treat significantly altered bowel function.

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“…Several potential mechanisms were offered in these studies for the slower recovery of right-sided resections, including that differential activation of retroperitoneal nerves, method of anastomosis (handsewn ileocolic vs. stapled colocolic/colorectal), and the choice of iso-or antiperistaltic ileocolic anastomosis may impact on gut functional recovery as well (Campana et al, 2017;Ibanez et al, 2019). As per Figure 1B, we propose an alternative mechanism, which although currently quite speculative has emerging physiological evidence, which is that the intact section of the distal colon may be physiologically responsible due to hyperactive CMPs.…”

Section: Gut Recovery Is Different After Right Vs Left Sided Colonicmentioning

confidence: 99%

Variable Gut Function Recovery After Right vs. Left Colectomy May Be Due to Rectosigmoid Hyperactivity

2021

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It is established that gut function recovers slower after right vs. left colectomies with higher rates of prolonged post-operative ileus (PPOI), but the reason is unclear. Development of PPOI is multifactorial. A recent manometry study in right colectomy patients showed that the distal colon becomes hyperactive after surgery with predominantly cyclic motor patterns (CMPs). In this perspective, we evaluate the hypothesis that the slower gut recovery after right hemicolectomy could be induced by a functional obstruction due to hyperactive CMPs.

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Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI)

Cited by 30 publications

References 30 publications

Comparison of the Clinical Outcomes Between Isoperistaltic and Antiperistaltic Anastomoses After Laparoscopic Distal Gastrectomy for Patients With Gastric Cancer

Comparison of the Clinical Outcomes Between Isoperistaltic and Antiperistaltic Anastomoses After Laparoscopic Distal Gastrectomy for Patients With Gastric Cancer

Systematic review: the effect of right hemicolectomy for cancer on postoperative bowel function

Variable Gut Function Recovery After Right vs. Left Colectomy May Be Due to Rectosigmoid Hyperactivity

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