title: Side-to-end vs. straight stapled colorectal anastomosis after low anterior resection: results of randomized clinical trial.
abstract: OBJECTIVE
  The aim of this study is to compare surgical, functional, physiologic outcomes and QOL after low anterior resection (LAR) with andside-to-end or straight colorectal anastomosis.
  
  
  METHODS
  Between 2012 and 2015, 86 patients with mid and low rectal tumors were enrolled into randomized trial. Wexner score, number of defecations, use of antidiarrheal medicine or laxatives, enemas, pads, episodes of nocturnal incontinence, and urgency were recorded. The Fecal Incontinence Quality of Life (FIQL) scale was used for assessment of QOL. Anal manometry and volumetric examination were performed.
  
  
  RESULTS
  Six patients were excluded from the study. There was no mortality. The morbidity rate was 6 (14.6 %) for side-to-end vs. 8 (20.0 %) for straight anastomosis (p = 0.57). The median Wexner score was 5 vs. 6 (p = 0.033), 4 vs. 5 (p = 0.006), and 2 vs. 3 (p = 0.1) at 1, 3, and 6 months after stoma reversal, respectively. Side-to-end anastomosis resulted in a fewer mean numbers of bowel movements per day at the same check points of follow-up: 5.8 ± 0.14 vs. 6.4 ± 0.15 (p = 0.006), 3.7 ± 0.1 vs. 4.2 ± 0.1 (p = 0.003), and 2.5 ± 0.1 vs. 3.0 ± 0.10 (p = 0.0002), correspondingly. Maximal tolerated volume was higher for side-to-end anastomosis at 3 and 6 months of follow-up: 152.0 vs. 137.8 cm(3) (p = 0.002) and 180.5 vs. 167.0 cm(3) (p = 0.006), respectively. Better FIQL score was found at 1 and 3 months in the side-to-end group.
  
  
  CONCLUSIONS
  Better functional outcomes and QOL were observed in a short period after stoma closure, but at 6 months of follow-up, the only benefit of side-to-end anastomosis was a lower number of bowel movements.
authors.affiliation: Department of Oncoproctology, State Scientific Centre of Coloproctology, Saliama Adila 2, Moscow, Russia, 123423. erybakov@gmail.com.
authors.forename: E G
authors.initials: EG
authors.lastname: Rybakov
authors.affiliation: Department of Oncoproctology, State Scientific Centre of Coloproctology, Saliama Adila 2, Moscow, Russia, 123423.
authors.forename: D Yu
authors.initials: DY
authors.lastname: Pikunov
authors.affiliation: Laboratory of clinical pathophysiology State Scientific Centre of Coloproctology, Moscow, Russia.
authors.forename: O Yu
authors.initials: OY
authors.lastname: Fomenko
authors.affiliation: Department of Oncoproctology, State Scientific Centre of Coloproctology, Saliama Adila 2, Moscow, Russia, 123423.
authors.forename: S V
authors.initials: SV
authors.lastname: Chernyshov
authors.affiliation: Director of State Scientific Centre of Coloproctology, Moscow, Russia.
authors.forename: Yu A
authors.initials: YA
authors.lastname: Shelygin
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D000714:Anastomosis, Surgical / Q000009:adverse effects; D015331:Cohort Studies; D003106:Colon / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation; D005242:Fecal Incontinence / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011312:Pressure; D011788:Quality of Life; D012007:Rectum / Q000503:physiopathology / Q000601:surgery*; D013528:Surgical Staplers / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Colorectal anastomosis; Low anterior resection; Side-to-end anastomosis