title: Meta-analysis of reconstruction techniques after low anterior resection for rectal cancer.
abstract: BACKGROUND
  Options for reconstruction after low anterior resection (LAR) for rectal cancer include straight or side-to-end coloanal anastomosis (CAA), colonic J pouch and transverse coloplasty. This systematic review compared these techniques in terms of function, surgical outcomes and quality of life.
  
  
  METHODS
  A systematic literature search (MEDLINE, Embase and the Cochrane Library, from inception of the databases until November 2014) was conducted to identify randomized clinical trials comparing reconstructive techniques after LAR. Random-effects meta-analyses were carried out, and results presented as weighted odds ratios or mean differences with corresponding 95 per cent c.i. A network meta-analysis was conducted for the outcome anastomotic leakage.
  
  
  RESULTS
  The search yielded 965 results; 21 trials comprising data from 1636 patients were included. Colonic J pouch was associated with lower stool frequency and antidiarrhoeal medication use for up to 1 year after surgery compared with straight CAA. Transverse coloplasty and side-to-end CAA had similar functional outcomes to the colonic J pouch. No superiority was found for any of the techniques in terms of anastomotic leak rate.
  
  
  CONCLUSIONS
  Colonic J pouch and side-to-end CAA or transverse coloplasty lead to a better functional outcome than straight CAA for the first year after surgery.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany.
authors.forename: F J
authors.initials: FJ
authors.lastname: Hüttner
authors.forename: S
authors.initials: S
authors.lastname: Tenckhoff
authors.forename: K
authors.initials: K
authors.lastname: Jensen
authors.forename: L
authors.initials: L
authors.lastname: Uhlmann
authors.forename: Y
authors.initials: Y
authors.lastname: Kulu
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.forename: M K
authors.initials: MK
authors.lastname: Diener
authors.forename: A
authors.initials: A
authors.lastname: Ulrich
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D006801:Humans; D016737:Proctocolectomy, Restorative; D019651:Plastic Surgery Procedures / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*