title: Isoperistaltic versus antiperistaltic stapled side-to-side anastomosis for colon cancer surgery: a randomized controlled trial.
abstract: BACKGROUND
  Isoperistaltic stapled side-to-side anastomosis (SSSA), which is a modified technique from conventional antiperistaltic SSSA, has the benefits of antiperistaltic SSSA but requires less intestinal mobility. The aim of this randomized controlled trial was to evaluate short-term outcomes of isoperistaltic SSSA comparing them with antiperistaltic SSSA during colon cancer surgery.
  
  
  METHODS
  We conducted a randomized controlled trial of patients with colon cancer who underwent elective curative resection and had enough intestinal mobility at anastomosis. The primary outcome was the presence of anastomotic failure, including leakage, hemorrhage, and stenosis.
  
  
  RESULTS
  Between July 2012 and January 2014, forty patients were enrolled (20 patients in each group). The study was suspended on detecting excess morbidity in the isoperistaltic SSSA group. No significant differences were observed in all preoperative backgrounds between the two groups. Anastomotic leakage was seen in two patients in the isoperistaltic SSSA group, compared with none in the antiperistaltic SSSA group, although the difference was not statistically significant (P = 0.487). One patient in the antiperistaltic SSSA group had anastomotic stenosis, which improved conservatively, compared with none in the isoperistaltic SSSA group (P = 1.000). No anastomotic hemorrhage was seen in either group. There was no significant difference in the median postoperative hospital stay (P = 0.313).
  
  
  CONCLUSIONS
  This study did not show any short-term advantage or disadvantage of isoperistaltic SSSA compared with that of antiperistaltic SSSA. However, considering that anastomotic leakage occurred only in the isoperistaltic SSSA group, additional modifications are recommended to perform safe isoperistaltic SSSA for colon surgery.
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan. Electronic address: a-matsu@nms.ac.jp.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Matsuda
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Miyashita
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sakurazawa
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
authors.forename: Marina
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013537:Sutures
keywords: Anastomosis; Colon cancer; Leakage; Stapled side-to-side anastomosis; Surgery