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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

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Abstract

Aims

To evaluate comparative outcomes of straight (end-to-end) anastomosis versus colonic J-pouch anastomosis following anterior resection.

Methods

A systematic search of multiple electronic data sources was conducted, and all studies comparing straight (end-to-end) anastomosis versus J-pouch anastomosis were included. Anastomotic complications, post-operative complications, re-operation, mortality, and functional outcomes were the evaluated outcome parameters. Revman 5.3 was used for data analysis.

Results

Twenty-seven studies reporting a total number of 3293 patients who underwent straight anastomosis (n = 1581) or J-pouch (n = 1712) were included. Anastomotic leak and re-operation rates were significantly higher in the straight group compared to the J-pouch group [RD 0.03, P = 0.03] and [OR 1.87, P = 0.003], respectively. Stool frequency per 24 h at 6 months and 12 months was lower in the J-pouch group than the straight group [MD 2.13, P = 0.003] and [MD 1.44, P = 0.00001], respectively. In addition, the use of anti-diarrheal medication is lower at 12 months in the J-pouch group [MD 3.85, P = 0.03]. Moreover, the two groups showed comparable results regarding SSI, sepsis, paralytic ileus, anastomotic stricture formation, anastomotic bleeding, and mortality.

Conclusion

J-pouch anastomosis showed lower risk for anastomotic leak and re-operation. Furthermore, better functional outcomes such as stool frequency were achieved using the colonic J-pouch reconstruction over the conventional straight end-to-end anastomosis.

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Author notes

  1. Ali Yasen Y. Mohamedahmed, Shafquat Zaman and Adewale Adeoba Ayeni contributed equally and proposed joint first authorship.

Authors and Affiliations

  1. Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, West Midlands, Birmingham, UK

    Shafquat Zaman, Ali Yasen Y. Mohamedahmed, Elizabeth Peterknecht, Sadiq Mawji, Mohamed Albendary & Rajnish Mankotia

  2. Department of General Surgery, The Dudley Group NHS Trust, Russells Hall Hospital, West Midlands, Dudley, UK

    Adewale Adeoba Ayeni & Akinfemi Akingboye

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  1. Shafquat Zaman
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Contributions

Conception and design: AAA, AYYM, SZ, and AA. Literature search and study selection: AA, SZ, and AYYM. Data collection: EP, AA, and SM. Analysis and interpretation: AYYM, SZ, and MA. Writing the article: All authors. Critical revision of the article: All authors. Final approval of the article: All authors.

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Correspondence to Ali Yasen Y. Mohamedahmed.

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This study is a systematic review with meta-analysis of outcomes which does not include research directly involving human or animal participation.

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Zaman, S., Mohamedahmed, A.Y.Y., Ayeni, A.A. et al. Comparison of the colonic J-pouch versus straight (end-to-end) anastomosis following low anterior resection: a systematic review and meta-analysis. Int J Colorectal Dis 37, 919–938 (2022). https://doi.org/10.1007/s00384-022-04130-w

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