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Meta-Analysis
. 2022 Apr;37(4):919-938.
doi: 10.1007/s00384-022-04130-w. Epub 2022 Mar 19.

Comparison of the colonic J-pouch versus straight (end-to-end) anastomosis following low anterior resection: a systematic review and meta-analysis

Shafquat Zaman #  1 , Ali Yasen Y Mohamedahmed #  2 , Adewale Adeoba Ayeni #  3 , Elizabeth Peterknecht  1 , Sadiq Mawji  1 , Mohamed Albendary  1 , Rajnish Mankotia  1 , Akinfemi Akingboye  3
Affiliations
Meta-Analysis

Comparison of the colonic J-pouch versus straight (end-to-end) anastomosis following low anterior resection: a systematic review and meta-analysis

Shafquat Zaman et al. Int J Colorectal Dis. 2022 Apr.

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.

Keywords: Anterior resection; J-pouch; Straight anastomosis.

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