Isoperistaltic versus antiperistaltic configuration for side-to-side bowel anastomosis: A systematic review and meta-analysis

Bowel anastomoses are an important component of colorectal surgeries, created to restore bowel continuity of the gastrointestinal tract. Numerous anastomosis techniques with great variation have been described. Despite this, there has been little discussion on the effect of anastomotic direction (isoperistaltic, antiperistaltic) on outcomes of anastomosis. Current evidence does not provide a clear benefit of one over the other. 489 studies were identified from EMBASE, Medline and Cochrane library. Full text review was conducted for 89 studies and 8 were included in final analyses. Analyses was conducted with Cochrane Review Manager (RevMan web). This study was conducted in line with Singhealth CIRB guidelines. 765 patients were included across 8 studies. Comparing antiperstaltic to isoperistaltic anastomosis, there were no significant difference in total complications (OR 0.95, 95 % CI: 0.65–1.39, p = 0.79). Antiperistaltic anastomosis resulted in return to bowel movement approximately half a day before isoperistaltic anastomosis (MD 0.55 days, 95 % CI:0.39–0.72, p = < 0.00001). Operative time for creation of isoperistaltic anastomosis when performed for Colon Cancer was faster (MD 7.09 min, 95 % CI: 0.58–13.60, p = 0.03). Intraoperative blood loss involving antiperistaltic anastomosis was lower compared to isoperistaltic anastomosis. (MD -1.49 mL, 95 % CI: −2.59 to −0.38, p = 0.008). Peristaltic direction of bowel anastomoses has small effects on surgical outcomes. There are multiple established surgical and patient factors that influence outcomes in bowel surgery - in this context, the direction of the bowel anastomoses may have diminished clinical significance. Inclusion of detailed surgical techniques in future publications would benefit further research on anastomotic technique and its outcomes.