Evidence for technique and standardisation
Overall, there is low quality evidence to support technical decision making in stapled right sided anastomoses
The ESCP 2015 audit found no association between the apical stapler type being cutting (e.g. GIA) or non-cutting (e.g. TA) and risk of anastomotic leak. It demonstrated no significant differences in the rate of anastomotic leak between oversewn and non-oversewn apical anastomoses in cutting and non-cutting groups.
Other observational studies have suggested that use of a cutting stapler to close the common enterotomy (Barcelona anastomosis) versus a non-cutting stapler (Transverse stapler closure) may convey some benefit, although this evidence is limited by its single centre and retrospective nature and is at high risk of bias. Again this paper found no benefit to routinely oversewing the anastomotic staple line.
Related paper: Common side closure type, but not stapler brand or oversewing, influences side-to-side anastomotic leak rates
In two small randomised controlled trials, there have been no differences detected between isoperistaltic and antiperistaltic configurations and the risk of anastomotic leak, or any other key clinical outcomes.
Related paper: Isoperistaltic versus antiperistaltic stapled side-to-side anastomosis for colon cancer surgery:a randomized controlled trial
Related paper: Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI)
The video below shows examples of antiperistaltic and isoperistaltic anastomotic configurations:
Whilst there is a low-quality evidence base in comparison of different anastomotic techniques, there is greater evidence to support that reducing unnecessary variation may benefit patients.
Several authors have reported improvement of results when standardisation of anastomotic technique is adopted into the clinical practice.
Related paper: Changes in Clinical Practice Reduce the Rate of Anastomotic Leakage After Colorectal Resections
The ESCP Safe-anastomosis programme recommends that your surgical team and department reviews the evidence base for decision making around anastomotic technique, and considers harmonising your technique to improve consistency, share experience, and reduce variation.