TURNBULL-CUTAIT PULL-THROUGH COLOANAL ANASTOMOSIS VERSUS STANDARD COLOANAL ANASTOMOSIS PLUS DIVERTING ILEOSTOMY FOR LOW ANTERIOR RESECTION: A META-ANALYSIS AND SYSTEMATIC REVIEW

Purpose Coloanal anastomosis with loop diverting ileostomy (CAA) is an option for low anterior resection of the rectum, and Turnbull-Cutait coloanal anastomosis (TCA) regained popularity in the effort to offer patients a reconstructive option.

Objective In this context, we aimed to compare both techniques.

Methods PubMed, Cochrane, and Scopus were searched for studies published until January 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p< 0.05. Heterogeneity was assessed using the Cochran Q test and I² statistics, with p-values inferior to 0.10 and I² > 25% considered significant. Statistical analysis was conducted in RStudio version 4.1.2 (R Foundation for Statistical Computing). Registered number CRD42024509963.

Results One randomized controlled trial and nine observational studies were included, comprising 1,743 patients, of whom 899 (51.5%) were submitted to TCA and 844 (48.5%) to CAA. Most patients had rectal cancer (52.2%), followed by megacolon secondary to Chagas disease (32.5%). TCA was associated with increased colon ischemia (OR 3.54; 95% CI 1.13 to 11.14; p < 0.031; I² = 0%). There were no differences in postoperative complications classified as Clavien-Dindo ≥ IIIb, anastomotic leak, pelvic abscess, intestinal obstruction, bleeding, permanent stoma, or anastomotic stricture. In subgroup analysis of patients with cancer, TCA was associated with a reduction in anastomotic leak (OR 0.55; 95% CI 0.31 to 0.97 p = 0.04; I² = 34%).

Conclusion TCA was associated with a decrease in anastomotic leak rate in subgroups analysis of patients with cancer.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025