Isoperistaltic versus antiperistaltic side-to-side ileocolic anastomosis in Crohn’s disease and right colon adenocarcinoma: Controlled clinical trial

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Published Feb 1, 2025
https://doi.org/10.62438/tunismed.v103i2.5460
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Vol. 103 No. 2 (2025): Tunis Med Feb 2025

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Mohamed Ali Chaouch
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Ward Mallek
Faculty of medicine of Monastir, Monastir University Hospital, Monastir, Tunisia
Sadok Ben Jabra
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Maissa Jallali
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Hanene Zenati
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Hiba Ben Hassine
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Abdesslem Ghedira
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Faiez Boughanmi
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Midani Touati
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Amina Chaka
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Ibtissem Korbi
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
Faouzi Noomen
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia

Abstract

Introduction: Ileocolonic anastomoses are frequent in colorectal surgeries, but anastomotic leakage remains a serious complication associated with increased morbidity and mortality. The optimal peristaltic orientation for anastomosis is still debated.


Aim: To evaluate and compare short- and long-term outcomes of isoperistaltic (IA) and antiperistaltic (AA) side-to-side ileocolic anastomoses after right colectomy or ileocecal resection for right-sided adenocarcinoma or Crohn’s disease. 


Methods: A single-center retrospective clinical trial was conducted at Fattouma Bourguiba University Hospital, Monastir, involving patients with right-sided colon cancer or ileocecal Crohn’s disease who underwent elective resection with either IA or AA. The primary outcome was anastomotic leakage, while secondary outcomes included postoperative morbidity and long-term results. 


Results: Ninety-four patients, including 55 with right-sided colon cancer and 39 with Crohn’s disease, were analyzed between January 2016 and July 2023. Of these, 48 underwent IA, and 46 underwent AA. Both anastomotic techniques exhibited similar leakage rates. Baseline and operative variables were comparable except for male predominance in AA for Crohn’s disease and a higher conversion rate in AA. No significant differences were noted regarding pathological variables, operative time, bowel transit recovery, oral tolerance, hospital stay, or postoperative complications. Multivariate analysis revealed that elevated white blood cell count, R2 resection, and mucinous adenocarcinoma were risk factors for anastomotic leakage, while albumin levels and staple line reinforcement were protective factors against postoperative morbidity. 


Conclusion: IA and AA demonstrated comparable safety and feasibility, though AA had a higher conversion rate. Further studies are required to optimize AA safety. 

Keywords:

Colon cancer, Crohn's disease, Ileocolic anastomosis, Stapled side-to-side anastomosis , Isoperistaltic, Antiperistaltic, Anastomotic Leak, Outcome, Controlled clinical trial

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