Isoperistaltic versus antiperistaltic side-to-side anastomosis after right laparoscopic hemicolectomy for cancer (ISOVANTI) trial: study protocol for a randomised clinical trial

Ibáñez, Noelia; Abrisqueta, Jesús; Luján, Juan; Hernández, Quiteria; P, Parrilla Paricio

doi:10.1007/s00384-017-2840-6

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…Table 2 shows the comparison between RCR and LCR groups in terms of bowel function recovery in postoperative period. Time to passage of rst atus was 3.07 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) days in RCR vs 1.44 (1-6) days in LCR group (p=0.008). Time to escalation to low residue diet was 4.29 (1-18) days in RCR vs 2.89 (1-16) days in LCR group (p=0.001).…”

Section: Resultsmentioning

confidence: 94%

“…Time to escalation to low residue diet was 4.15 (1-18) days in LRCR vs 2.66 (1-16) days in LLCR group (p=0.002). Time to passage of rst atus was 3.53 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) days in LRCR vs 2.24 (1-5) days in LLCR group (p=0.000). Fifteen (36.6%) patients in LRCR and 12 (13.3%) in LLCR groups had postoperative ileus (p=0.004).…”

Section: Resultsmentioning

confidence: 95%

“…This results in a diverticulum-like anastomosis with fecal stasis, which could theoretically contribute to slower bowel function recovery. [7] Further studies are required to substantiate these observations. Secondly, loss of ileocecal valve and chemical nature of bowel contents at ileo-colic anastomosis could impact bowel function recovery.…”

Section: Discussionmentioning

confidence: 99%

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Differences in short-term outcomes after right and left sided colorectal resections for colorectal cancer may indicate a need for modification of ERAS protocol elements

Mantoo

Goh

2022

Preprint

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Purpose: Our study aims to compare postoperative bowel function recovery between standard right and left sided colorectal resections and explore the need to modify ERAS protocol for right sided colonic resections.Methods: data from a prospective database of elective right colonic resections (RCR) and left colorectal resections (LCR) between January 2016 to December 2019 was analyzed. Primary outcome was to compare return of bowel function and development of post-operative ileus between RCR and the LCR groups. Secondary outcomes were length of stay, post-operative complications, 30-day re-admission, and re-operation rates.Results: Of 193 eligible patients, 72 (37.3%) were in RCR group while 171 (62.7%) were in LCR group. Laparoscopic approach was used in (41/72) 56.9% of RCR group and (90/121) 74.4% in the LCR group. Time to escalation to low residue diet was 4.29 (1-18) days in RCR vs 2.89 (1-16) days in LCR group, p=0.001. Time to flatus was 3.07 (1-12) days in RCR group and 2.44 (1-6) days in LCR group, p=0.008. 21(29.2%) patients in RCR and 16 (13.2%) in LCR groups had postoperative ileus, p=0.007. Male sex and right colonic resections were found to be significant and independent risk factors for post-operative ileus after uni- and multivariate analysis. Conclusion: Right colonic resections are associated with delayed postoperative bowel function even after high compliance with ERAS protocol. Modification of ERAS protocol elements related to postoperative feeding and addition of new interventions may help to avoid delayed bowel function recovery.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 95%

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Differences in short-term outcomes after right and left sided colorectal resections for colorectal cancer may indicate a need for modification of ERAS protocol elements

Mantoo

Goh

2022

Preprint

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“…Another explanation could be that the colonic peristalsis and transit are regulated by the ileocecal valve. The ileocecal valve’s loss during RC and bowel disturbances are due to bacterial translocation from the colon to the small intestine [ 29 , 30 ]. A third explanation could be the increased trauma to the small bowel associated with an ileocolic anastomosis compared to a more distal anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of prolonged postoperative ileus between laparoscopic right and left colectomy under enhanced recovery after surgery: a propensity score matching analysis

et al. 2022

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Background There were differences in the recovery of bowel function and prolonged postoperative ileus (PPOI) between laparoscopic right colectomy (RC) and left colectomy (LC) under the guidance of enhanced recovery after surgery. Methods We selected 870 patients who underwent elective laparoscopic colectomy from June 2016 to December 2021, including 272 patients who had RC and 598 who had LC. According to 1:1 proportion for propensity score matching and correlation analysis, 247 patients who had RC and 247 who had LC were finally enrolled. Results The incidence of PPOI in all patients was 13.1%. Age, sex, smoking habit, preoperative serum albumin level, operation type, and operation time were the important independent risk factors based on multivariate logistic regression and correlation analysis for PPOI (p<0.05). Age, sex, body mass index, preoperative serum albumin level, operation time, and degree of differentiation between the two groups were significantly different before case matching (p<0.05). There were no statistically significant differences in baseline characteristics and preoperative biochemical parameters between the two groups after case matching (p>0.05). The incidence of PPOI in patients who had RC was 21.9%, while that in patients who had LC was 13.0%. The first flatus, first semi-liquid, and length of stay in LC patients were lower than those in RC patients (p<0.05). Conclusion The return of bowel function in LC was faster than that in RC, and the incidence of PPOI was relatively lower. Therefore, caution should be taken during the early feeding of patients who had laparoscopic RC.

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“…There remains significant procedural variation that was not explored, for example placement of a ‘crotch’ stitch to reduce stress across the confluence of the primary staple line, staple height (i.e. different stapler cartridges), tissue compression technique prior to cutting and isoperistaltic vs antiperistaltic configuration .…”

Section: Discussionmentioning

confidence: 99%

The impact of stapling technique and surgeon specialism on anastomotic failure after right‐sided colorectal resection: an international multicentre, prospective audit

2018

Colorectal Disease

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This study did not identify any difference in anastomotic leak rates according to the type of stapling device used to close the apical aspect. In addition, oversewing of the anastomotic staple lines appears to confer no benefit in terms of reducing leak rates. Although general surgeons operated on patients with more high-risk characteristics than colorectal surgeons, a higher leak rate for general surgeons which remained after risk adjustment needs further exploration.

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Isoperistaltic versus antiperistaltic side-to-side anastomosis after right laparoscopic hemicolectomy for cancer (ISOVANTI) trial: study protocol for a randomised clinical trial

Abstract: NCT02309931.

Cited by 10 publications

References 24 publications

Differences in short-term outcomes after right and left sided colorectal resections for colorectal cancer may indicate a need for modification of ERAS protocol elements

Differences in short-term outcomes after right and left sided colorectal resections for colorectal cancer may indicate a need for modification of ERAS protocol elements

Comparison of prolonged postoperative ileus between laparoscopic right and left colectomy under enhanced recovery after surgery: a propensity score matching analysis

The impact of stapling technique and surgeon specialism on anastomotic failure after right‐sided colorectal resection: an international multicentre, prospective audit

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