A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn's disease.
OBJECTIVE
This study compared outcomes between end-to-end anastomosis and other anastomotic configurations after intestinal resection for patients with Crohn's disease by using meta-analytical techniques.


METHODS
Comparative studies published between 1992 and 2005 of end-to-end anastomosis vs. other anastomotic configurations were included. Using a random effects model, end points evaluated were short-term complications and perianastomotic recurrence of Crohn's disease. Heterogeneity was assessed and sensitivity analysis was performed to account for bias in patient selection.


RESULTS
Eight studies (2 prospective, randomized, controlled trials; 1 nonrandomized, prospective; 5 nonrandomized, retrospective studies) reported on 661 patients who underwent 712 anastomoses, of which 383 (53.8 percent) were sutured end-to-end anastomosis and 329 (46.2 percent) were other anastomotic configurations (259 stapled side-to-side, 59 end-to-side or side-to-end, 11 stapled circular end-to-end). Anastomotic leak rate was significantly reduced in the other anastomotic configurations group (odds ratio (OR), 4.37; P = 0.02) and remained significantly lower in studies comparing only side-to-side anastomosis vs. end-to-end anastomosis (OR, 4.37; P = 0.02) and studies including only ileocolonic anastomosis (OR, 3.8; P = 0.05). Overall postoperative complications (OR, 2.64; P < 0.001), complications other than anastomotic leak (OR, 1.89; P = 0.04), and postoperative hospital stay (weighted mean difference, 2.81; P = 0.007) were significantly reduced in the side-to-side anastomosis group when considering studies comparing only side-to-side anastomosis vs. end-to-end anastomosis. There was no significant difference between the groups in perianastomotic recurrence and reoperation needed because of perianastomotic recurrence.


CONCLUSIONS
End-to-end anastomosis after resection for Crohn's disease may be associated with increased anastomotic leak rates. Side-to-side anastomosis may lead to fewer anastomotic leaks and overall postoperative complications, a shorter hospital stay, and a perianastomotic recurrence rate comparable to end-to-end anastomosis. Further randomized, controlled trials should be performed for confirmation.
Department of Biosurgery and Surgical Technology, Imperial College London, London, United Kingdom.
Constantinos
C
Simillis
Sanjay
S
Purkayastha
Takayuki
T
Yamamoto
Scott A
SA
Strong
Ara W
AW
Darzi
Paris P
PP
Tekkis
D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods*; D003082:Colectomy; D003424:Crohn Disease / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D016896:Treatment Outcome