Comparison study of two anastomosis techniques in right hemicolectomy: a systematic review and pooling up analysis

Abstract

Purpose: This study aims to compare side-to-side anastomosis (SSA) and end-to-side anastomosis (ESA) in laparoscopic right hemicolectomy from multiple perspectives to guide the selection of the optimal anastomotic technique. Methods: This review was pre-registered with PROSPERO (CRD42024614418). A comprehensive literature search was performed using Embase, PubMed, Cochrane Library, and China Biology Medicine (CBM). The primary outcome was anastomotic complications, and secondary outcomes included non-anastomotic complications, short-term prognosis, and surgical parameters. Results: A total of 18 articles involving 14,555 participants were included in this systematic review and meta-analysis. No significant difference was found between SSA and ESA regarding overall anastomotic complications (OR = 1.14, 95% CI = 0.81 to 1.62, P = 0.45). However, SSA showed advantages in reducing postoperative anastomotic bleeding (OR = 0.64, 95% CI = 0.45 to 0.90, P = 0.01), while ESA appeared more favorable for reducing anastomotic leakage (AL) (OR = 1.29, 95% CI = 0.97 to 1.73, P = 0.08) and intestinal obstruction (OR = 1.20, 95% CI = 0.99 to 1.47, P = 0.07), though these differences were not statistically significant. No significant differences were found in non-anastomotic complications, short-term prognosis, or surgical parameters. Conclusion: Current clinical evidence suggests that SSA is more effective than ESA in reducing postoperative anastomotic bleeding during right hemicolectomy for cancer. However, no significant differences were observed between the two techniques regarding overall anastomotic.