Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection.
METHODS
The comparative benefits and drawbacks of straight coloanal anastomosis (CAA), colonic J-pouch and coloplasty anastomosis after anterior resection are uncertain. Studies published between 1986 and 2005 of colonic J-pouch versus transverse coloplasty or straight CAA were analysed. Endpoints included postoperative complications, and functional and physiological outcomes measured within 6 months, 1 year and 2 years or more after the procedure. A random-effect model was used to aggregate the study endpoints and assess heterogeneity.


RESULTS
Thirty-five studies containing 2240 patients (1066 straight CAA, 1050 J-pouch and 124 coloplasty) were included. There was no significant difference in postoperative complications between the three groups. There was a significant reduction in the frequency of defaecation per day by 1.88, 1.35 and 0.74 motions at the three time intervals in the J-pouch group compared with the straight CAA group. Faecal urgency was less prevalent in patients with a J-pouch than those with a straight CAA (odds ratio 0.27 at 6 months or less and 0.21 at 1 year). There was no difference in functional outcome between J-pouch and coloplasty anastomosis.


CONCLUSIONS
The colonic J-pouch provided functional benefits over straight anastomosis with no increase in postoperative complications. Coloplasty appeared to have similar benefits but further studies are required for validation.
Heriot
A G
AG
Department of Surgical Oncology and Technology, Imperial College London, St Mary's Hospital, London, UK.
Tekkis
P P
PP
Constantinides
V
V
Paraskevas
P
P
Nicholls
R J
RJ
Darzi
A
A
Fazio
V W
VW
D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D039021:Colonic Pouches; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome