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Updated: Jun 15, 2025

Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Preoperative anastomotic evaluation prior to ileostomy closure: A 5-year UK survey, systematic review, and
D Atraszkiewicz1, T Shakir2, C Harrington3
1Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Chelmsford, UK.
Aim:
To compare current UK surgical practice against evidence-based anastomotic evaluation techniques prior to ileostomy closure.
Methods:
An online survey was distributed to UK consultant colorectal surgeons with Association of Coloproctology of Great Britain and Ireland affiliation to assess preoperative investigations. Data were collected at two timepoints: 2019 and 2024. A systematic review and meta-analysis were performed utilising PRISMA guidelines. MEDLINE (PubMed), Embase and Education Resources Information Center databases were evaluated from inception to 27 March 2024. Inclusion criteria were adult patients (≥18 years), distal colonic/pelvic anastomosis and defunctioning ileostomy reversal. ROBINS-I bias assessments were conducted. DerSimonian and Laird random-effects analyses were performed on eligible sensitivity and specificity data with forest plots generated.
Prospero Id:
CRD42024520236.
Results:
The survey received 221 (41.0%) and 212 (40.7%) responses in 2019 and 2024 respectively. Pre- and post-pandemic practice was consistent. Water-soluble contrast enema (WCE) and digital rectal examination (DRE) were the most utilised, performed 'always' by 83.2% and 78.7% respectively. Thirty-seven studies (5061 patients) were included for systematic review; 12 studies (1385 patients) for meta-analysis. Studies were heterogeneous in methodology; no randomised controlled trials were identified. Endoscopy showed higher sensitivity (73.1%) compared to retrograde contrast studies (WCE and pouchography; 53.1%) in identifying anastomotic leaks. Specificity was similar: 100% and 98.0% respectively. Significant heterogeneity and a lack of eligible studies limited further interpretation. CT has a limited evidence base for anastomotic evaluation.
Conclusions:
The most commonly performed anastomotic evaluation methods in the UK are WCE and DRE. Endoscopy, however, has a greater sensitivity and specificity for identifying anastomotic complications. WCE is an effective option to confirm suspected leaks. Endoscopy should be considered to evaluate anastomotic integrity prior to ileostomy closure.
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