• F J Hüttner, S Tenckhoff, K Jensen, L Uhlmann, Y Kulu, M W Büchler, M K Diener, and A Ulrich.
• Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany.
• Br J Surg. 2015 Jun 1; 102 (7): 735745735-45.

BackgroundOptions for reconstruction after low anterior resection (LAR) for rectal cancer include straight or side-to-end coloanal anastomosis (CAA), colonic J pouch and transverse coloplasty. This systematic review compared these techniques in terms of function, surgical outcomes and quality of life.MethodsA systematic literature search (MEDLINE, Embase and the Cochrane Library, from inception of the databases until November 2014) was conducted to identify randomized clinical trials comparing reconstructive techniques after LAR. Random-effects meta-analyses were carried out, and results presented as weighted odds ratios or mean differences with corresponding 95 per cent c.i. A network meta-analysis was conducted for the outcome anastomotic leakage.ResultsThe search yielded 965 results; 21 trials comprising data from 1636 patients were included. Colonic J pouch was associated with lower stool frequency and antidiarrhoeal medication use for up to 1 year after surgery compared with straight CAA. Transverse coloplasty and side-to-end CAA had similar functional outcomes to the colonic J pouch. No superiority was found for any of the techniques in terms of anastomotic leak rate.ConclusionColonic J pouch and side-to-end CAA or transverse coloplasty lead to a better functional outcome than straight CAA for the first year after surgery.© 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

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