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. 2025 Jan-Jun;15(1):44-49.
doi: 10.5005/jp-journals-10018-1469. Epub 2025 Jun 18.

Isoperistaltic Side-to-side Anastomosis in Colorectal Surgery: Outcomes and Comparative Insights from Bahrain

Ahmed T Algahiny  1 , Mohamed Bg Elnagar  1 , Omar Smms Elmitwalli  1 , Hosam Alazazzi  1 , Ibrahim Asim  1 , Omar HeshamEldin Abouelella  2 , Isam M Juma  3 , Mirza Faraz Saeed  3
Affiliations

Isoperistaltic Side-to-side Anastomosis in Colorectal Surgery: Outcomes and Comparative Insights from Bahrain

Ahmed T Algahiny et al. Euroasian J Hepatogastroenterol. 2025 Jan-Jun.

Abstract

Introduction: Colorectal cancer (CRC) is the third most common malignancy and a major cause of cancer-related mortality worldwide. The optimal anastomosis technique after surgical resection remains controversial, as each method presents distinct advantages and drawbacks. In particular, antiperistaltic and isoperistaltic side-to-side anastomosis (SSA) are associated with varying benefits and postoperative outcomes. This study highlights the benefits of isoperistaltic SSA and compares its outcomes with existing literature on antiperistaltic techniques.

Methods: A retrospective cohort study was conducted at King Hamad University Hospital, Bahrain, from February 2019 to September 2023, involving 24 patients undergoing laparoscopic or open right hemicolectomy with isoperistaltic SSA. Data collected included demographics, operative characteristics, and postoperative outcomes.

Results: The cohort had a mean age of 56.17 years with 58.3% of the cohort being male. The average operative time was 207.5 minutes, with minimal blood loss and low transfusion rates. Early complications included nausea and vomiting in 20.83% of patients; no anastomotic leakage or stenosis was observed. The mean hospital stay was 6.33 days, and only one readmission occurred. Long-term complications included hernias (16.67%) and transient diarrhea, with no cases of chronic diarrhea or bowel obstruction.

Conclusion: Our findings indicate that isoperistaltic anastomosis was associated with lower complication rates compared to outcomes for antiperistaltic anastomosis reported in the literature. Notably, reinforced hand-sewn sutures appeared to further improve surgical results and reduce leakage. These observations suggest that reinforcement methods may have a greater impact on outcomes than anastomosis orientation itself. However, larger, controlled studies are necessary to confirm these findings.

How to cite this study: Algahiny AT, Elnagar MBG, Elmitwalli OSMMS, et al. Isoperistaltic Side-to-side Anastomosis in Colorectal Surgery: Outcomes and Comparative Insights from Bahrain. Euroasian J Hepato-Gastroenterol 2025;15(1):44-49.

Keywords: Antiperistatical; Colorectal cancer; Isoperistaltic; Right hemicolectomy; Side-to-side anastomosis.

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Conflict of interest statement

Source of support: Nil Conflict of interest: NoneConflict of interest: None

Figures

Fig. 1
Fig. 1
Schematic overview of side-to-side anastomosis of colon (above) and ileum (below) in the isoperistaltic configuration (left) and antiperistaltic configuration (right)—black staple line indicating end transection, red line indicating sutures joining the anastomosis, green line indicating sutures closing the system, with directions of peristalsis represented by blue arrows
See this image and copyright information in PMC

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