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

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Abstract

Background

Right hemicolectomy is a very common surgery. Many studies compare different options for laparoscopic ileocolic anastomoses: intra- or extracorporeal; handsewn or stapled; side-to-side or end-to-side. However, there are no studies about the influence that peristalsis could have on this anastomosis. The aim of this study is to compare safety and feasibility of isoperistaltic and antiperistaltic anastomosis in terms of postoperative morbidity and mortality between both groups. The secondary endpoint is to compare long-term functional outcomes (chronic diarrhoea) and quality of life (GIQLI questionnaire) after a 1-year follow-up period.

Methods

A double-blind, randomised, prospective trial in patients undergoing scheduled surgery for right colon cancer with laparoscopic right hemicolectomy and isoperistaltic (ISO) or antiperistaltic (ANTI) ileocolic anastomoses.

Results

Hundred and eight patients were included in the study. Patients were randomised either to isoperistaltic or antiperistaltic configuration (54 ISO/ANTI). No significant differences in baseline variables were found. No differences in surgical time (130 [120–150] min ISO vs. 140 [127–160] ANTI, p = 0.481), nor in anastomotic time (19 [17–22] vs. 20 [16–25], p = 0.207) and nor in postoperative complications: 37.0% ISO versus 40.7% ANTI, (p = 0.693) were found. There were no differences in postoperative ileus (p = 0.112) nor in anastomotic leakage (3.7% vs. 5.56%, p = 1.00). Differences in “time to first flatus” and “time to first deposition” were found in favour of the antiperistaltic group (p = 0.004 and p = 0.017). Anastomotic configuration did not influence hospital stay (3 days [2–6] isoperistaltic vs. 3 [2–4] antiperistaltic, p = 0.236). During follow-up, there were no differences between the two groups at 1, 6 and 12 months (p = 0.154, p = 0.498 and p = 0.683), nor in chronic diarrhoea rates in GIQLI scores (24% ISO vs. 31.4% ANTI, p = 0.541).

Conclusions

The isoperistaltic and antiperistaltic ileocolic anastomosis present similar results in terms of performance, safety and functionality. However, further studies must be carried out in order to assess relationship between postoperative ileus and anastomosis configuration.

Trial registration

Randomised Clinical trial (Identifier: NCT02309931).

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Author notes

  1. Noelia Ibáñez and Jesús Abrisqueta contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Colorectal Unit, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain

    Noelia Ibáñez, Jesús Abrisqueta, Juan Luján & Quiteria Hernández

  2. Department of General Surgery, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain

    María Dolores Rufete & Pascual Parrilla

Authors
  1. Noelia Ibáñez
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  2. Jesús Abrisqueta
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  4. Quiteria Hernández
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  5. María Dolores Rufete
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Contributions

Conception and design: NI, JA, JL. Acquisition of a substantial portion of data: NI, JA, MDR, QH. Analysis and interpretation of data: NI, JA, MDR. Drafting of the manuscript: NI, JA, JL. Critical revision of the manuscript for important intellectual content: JL, PP. Statistical expertise: NI, JL. Obtaining funding for this project or study: no specific funding was used for this study. Supervision: JA, JL, PP. Final approval of the version to be published: NI, JA, JL, MDR, QH, PP.

Corresponding author

Correspondence to Jesús Abrisqueta.

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Disclosures

Noelia Ibáñez, Jesús Abrisqueta, Juan Luján, Quiteria Hernández, María Dolores Rufete and Pascual Parrilla have no conflicts of interest or financial ties to disclose.

Additional information

This paper is based on a previous communication to the Spanish National Coloproctology Meeting and it won the first price as best congress’ communication.

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Ibáñez, N., Abrisqueta, J., Luján, J. et al. Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI). Surg Endosc 33, 2850–2857 (2019). https://doi.org/10.1007/s00464-018-6580-7

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