Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection

• Published in: British journal of surgery Vol. 93; no. 1; pp. 19 - 32
• Main Authors: Heriot, A. G., Tekkis, P. P., Constantinides, V., Paraskevas, P., Nicholls, R. J., Darzi, A., Fazio, V. W.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-01-2006; Wiley
• Subjects: Anal Canal - surgery; Anastomosis, Surgical - methods; Biological and medical sciences; Colon - surgery; Colonic Diseases - surgery; Colonic Pouches; General aspects; Humans; Medical sciences; Randomized Controlled Trials as Topic; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Medicine; Resection; Treatment; Coloanal anastomosis; Surgery; Anterior; Comparative study; Colonic pouch; Metaanalysis
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.5188

Background and methods:
The comparative benefits and drawbacks of straight coloanal anastomosis (CAA), colonic $\font\ss=cmss10 scaled 1000 \hbox{\ss J}$‐pouch and coloplasty anastomosis after anterior resection are uncertain. Studies published between 1986 and 2005 of colonic $\font\ss=cmss10 scaled 1000 \hbox{\ss J}$‐pouch versus transverse coloplasty or straight CAA were analysed. Endpoints included postoperative complications, and functional and physiological outcomes measured within 6 months, 1 year and 2 years or more after the procedure. A random‐effect model was used to aggregate the study endpoints and assess heterogeneity.
Results:
Thirty‐five studies containing 2240 patients (1066 straight CAA, 1050 $\font\ss=cmss10 scaled 1000 \hbox{\ss J}$‐pouch and 124 coloplasty) were included. There was no significant difference in postoperative complications between the three groups. There was a significant reduction in the frequency of defaecation per day by 1·88, 1·35 and 0·74 motions at the three time intervals in the $\font\ss=cmss10 scaled 1000 \hbox{\ss J}$‐pouch group compared with the straight CAA group. Faecal urgency was less prevalent in patients with a $\font\ss=cmss10 scaled 1000 \hbox{\ss J}$‐pouch than those with a straight CAA (odds ratio 0·27 at 6 months or less and 0·21 at 1 year). There was no difference in functional outcome between $\font\ss=cmss10 scaled 1000 \hbox{\ss J}$‐pouch and coloplasty anastomosis.
Conclusions:
The colonic $\font\ss=cmss10 scaled 1000 \hbox{\ss J}$‐pouch provided functional benefits over straight anastomosis with no increase in postoperative complications. Coloplasty appeared to have similar benefits but further studies are required for validation. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd
$\font\ss=cmss10 scaled 1000 \hbox{\ss J}$‐pouch advocated