# Isoperistaltic Versus Antiperistaltic Side-to-Side Ileocolic Anastomoses After Right Colectomies: A Systematic Review and Meta-Analysis

## TL;DR

This study compares two types of ileocolic anastomoses after right colectomy and finds they have similar outcomes, except one type leads to faster bowel recovery.

## Contribution

A systematic review and meta-analysis comparing isoperistaltic and antiperistaltic ileocolic anastomoses for postoperative outcomes.

## Key findings

- Isoperistaltic anastomoses led to earlier return of flatus compared to antiperistaltic ones.
- No significant differences were found in complications like anastomotic leak or surgical site infection.
- Both anastomosis types showed similar operative times, blood loss, and hospital stay durations.

## Abstract

After right colectomy, ileocolic anastomoses can be configured as isoperistaltic (ISO) or antiperistaltic (ANTI), with the choice largely based on the surgeon’s experience. This study aimed to evaluate these configurations regarding postoperative complications and operative outcomes. We searched PubMed, Scopus, and the Cochrane Central Register of Clinical Trials for studies published up to January 2025. Odds ratios (ORs) and mean differences (MDs), with 95% confidence intervals (CIs), were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and analyses were conducted with R Software version 4.4.1.

Twelve studies involving patients undergoing colorectal surgery were included, comparing ISO and ANTI ileocolic anastomoses. ISO was associated with a significantly earlier return of flatus (MD: -0.3 days; 95% CI: -0.6 to -0.1; p<0.01). No statistically significant differences were found in anastomotic leak (OR: 0.61; 95% CI: 0.29-1.28; p=0.189), postoperative ileus (OR: 1.47; 95% CI: 0.87-2.50; p=0.149), anastomotic bleeding (OR: 0.70; 95% CI: 0.20-2.49; p=0.582), surgical site infection (SSI) (OR: 0.91; 95% CI: 0.38-2.17; p=0.829), reoperation (OR: 0.92; 95% CI: 0.47-1.82; p=0.813), time to first stool (MD: -0.3 days; 95% CI: -0.7 to 0.1; p=0.19), anastomotic time (MD: -0.2 minutes; 95% CI: -1.9 to 1.4; p=0.79), blood loss (MD: -4.0 mL; 95% CI: -17.8 to 9.8; p=0.57), operative time (MD: 4.2 minutes; 95% CI: -3.0 to 11.3; p=0.25), hospital stay (MD: -0.7 days; 95% CI: -1.7 to 0.4; p=0.19), or 30-day mortality (OR: 0.85; 95% CI: 0.25-2.86; p=0.787). Based on our findings, ISO and ANTI ileocolic anastomoses demonstrated comparable postoperative complication rates and operative outcomes. However, ISO was associated with a faster return of bowel function, evidenced by earlier passage of flatus.