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Background and purpose <p>Two main side-to-side anastomosis techniques are used in minimally invasive radical right hemicolectomy: the traditional antiperistaltic (ANTI) and the more recently adopted isoperistaltic (ISO) overlap method. Their comparative clinical efficacy remains controversial. This study aimed to evaluate the effectiveness and safety of ISO versus ANTI for ileocolic anastomosis, providing evidence-based guidance for surgical technique selection.</p> Methods <p>We systematically searched CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, Web of Science, and Cochrane Library from database inception to January 2026 for studies comparing ANTI and ISO. Cohort study quality was assessed using the Newcastle-Ottawa Scale, and randomized controlled trials (RCTs) were assessed using the Cochrane tools. Meta-analysis, sensitivity analysis, and publication bias evaluation were performed using RevMan 5.3 and STATA 17.</p> Results <p>Six studies (5 cohorts, 1 RCTs) comprising 931 patients were included. The meta-analysis indicated that the incidence of bowel obstruction was higher in the ANTI group than in the ISO group, with a borderline significant difference [RR = 1.75, 95% CI (1.01, 3.05), <i>P</i> = 0.05], and the ANTI group required a longer anastomosis time [MD = 1.03, 95% CI (0.35, 1.71), <i>P</i> = 0.003]. No significant differences were found between the two techniques regarding anastomotic leakage, anastomotic bleeding, time to first flatus, time to first defecation, readmission rate, surgery-related mortality, intra-abdominal infection, wound infection, chronic diarrhea, operative time, hospital stay, intraoperative blood loss, or time to first oral intake (all <i>P</i> &gt; 0.05). Sensitivity analysis revealed significantly longer total operative time for ANTI [MD = 8.75, 95% CI (6.11, 11.39), <i>P</i> &lt; 0.00001]. No reversal occurred in the results for other outcomes, indicating robust findings in this study. Publication bias risk analysis showed that publication bias was unlikely in this study.</p> Conclusions <p>Both anastomotic methods are effective and safe in minimally invasive radical right hemicolectomy. The ISO may offer modest technical advantages, but current evidence does not justify a strong preferential recommendation.</p>

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The effectiveness and safety of isoperistaltic versus antiperistaltic side-to-side ileocolic anastomosis in minimally invasive radical right hemicolectomy: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Hangjun Ren,
  • Sen Lu,
  • Yi Sun,
  • Quan Zhang,
  • Yan Shen

摘要

Background and purpose

Two main side-to-side anastomosis techniques are used in minimally invasive radical right hemicolectomy: the traditional antiperistaltic (ANTI) and the more recently adopted isoperistaltic (ISO) overlap method. Their comparative clinical efficacy remains controversial. This study aimed to evaluate the effectiveness and safety of ISO versus ANTI for ileocolic anastomosis, providing evidence-based guidance for surgical technique selection.

Methods

We systematically searched CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, Web of Science, and Cochrane Library from database inception to January 2026 for studies comparing ANTI and ISO. Cohort study quality was assessed using the Newcastle-Ottawa Scale, and randomized controlled trials (RCTs) were assessed using the Cochrane tools. Meta-analysis, sensitivity analysis, and publication bias evaluation were performed using RevMan 5.3 and STATA 17.

Results

Six studies (5 cohorts, 1 RCTs) comprising 931 patients were included. The meta-analysis indicated that the incidence of bowel obstruction was higher in the ANTI group than in the ISO group, with a borderline significant difference [RR = 1.75, 95% CI (1.01, 3.05), P = 0.05], and the ANTI group required a longer anastomosis time [MD = 1.03, 95% CI (0.35, 1.71), P = 0.003]. No significant differences were found between the two techniques regarding anastomotic leakage, anastomotic bleeding, time to first flatus, time to first defecation, readmission rate, surgery-related mortality, intra-abdominal infection, wound infection, chronic diarrhea, operative time, hospital stay, intraoperative blood loss, or time to first oral intake (all P > 0.05). Sensitivity analysis revealed significantly longer total operative time for ANTI [MD = 8.75, 95% CI (6.11, 11.39), P < 0.00001]. No reversal occurred in the results for other outcomes, indicating robust findings in this study. Publication bias risk analysis showed that publication bias was unlikely in this study.

Conclusions

Both anastomotic methods are effective and safe in minimally invasive radical right hemicolectomy. The ISO may offer modest technical advantages, but current evidence does not justify a strong preferential recommendation.