Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

Abstract

Background The use of laparoscopy for right hemicolectomy has gained popularity allowing the option of a totally laparoscopic intracorporeal anastomosis (IA) for intestinal reconstruction. This technique may alleviate some of the technical limitations that a surgeon faces with a laparoscopic-assisted extracorporeal anastomosis (EA). Results A total of 195 patients underwent laparoscopic right hemicolectomy over the study period, with 86 (44 %) patients receiving IA and 109 (56 %) patients receiving an EA. The most common indication for surgery in both groups was cancer: 56 (65 %) of IA cases and 57 (52 %) of EA cases. IA had a significantly higher rate of minor complications but no difference in serious complications compared to EA. Conversion to open resection was higher in EA. Using multivariate analysis to compare IA versus EA, there was no significant difference in length of stay, return of bowel function, risk of anastomotic leak, risk of intraabdominal abscess or risk of wound complications. Amongst cancer resections, there was no significant difference in the median number of lymph nodes harvested (18 LNs in IA group vs. 19 LNs in EA group, P > 0.05). There was also no significant difference in overall survival and disease-free survival at 5.7 years between the two groups. MethodsConclusions IA in laparoscopic right hemicolectomy is associated with similar postoperative and oncologic outcomes compared to EA. IA may possess advantages in terms of conversion and flexibility of specimen extraction, but this is counterbalanced by a higher incidence of minor complications. These findings suggest that IA represents a valid technique in the arsenal of the experienced colorectal surgeon without compromising outcomes.

Comparative study between hand sewn and stapled anastomosis in laparoscopic right hemicolectomy

“…But in the study of Jian-Cheng et al, who had mean resuming oral intake of 27±7 hours in the stapled group while the meantime of resuming the oral intake in the hand sewn group was 54±9 hours. 6,7 The mean hospital stay in the first group in this study was 4.47±2.13 days and in the second group the mean hospital stay was 6.60±1.30 days in agreement with the study of Phelan MJ et al, where the hospital stay after the operation in the stapled group was 3±2 days and in the hand sewn group the mean was 6±1 days. 7 But in disagreement with Jian-Cheng et al, who had the mean hospital stay after operation in the first group 10±2 days and in the second group the mean was 12±1 day.…”

“…6,7 The mean hospital stay in the first group in this study was 4.47±2.13 days and in the second group the mean hospital stay was 6.60±1.30 days in agreement with the study of Phelan MJ et al, where the hospital stay after the operation in the stapled group was 3±2 days and in the hand sewn group the mean was 6±1 days. 7 But in disagreement with Jian-Cheng et al, who had the mean hospital stay after operation in the first group 10±2 days and in the second group the mean was 12±1 day. 6 In the study by Thakor et al, hospital stay in the stapled group (34 cases) was 11.59 days and in the hand sewn group (34 cases) it was 12.69 days.…”

“…Phelan et al, studied the short and long-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy, the incidence of patients presented by anemia were (50.6%) while patients presented with weight loss were (49.4%) but in the study by Grams J et al, in the first group the cases presented with anemia were 30 patients (58.8%) and cases presented by weight loss were 43 patients (66.8%) in the second group the cases presented by anemia were 29 cases (45%) and the cases were presented by weight loss 39 patients (52%). 7,8 All patients in this study had CT abdomen with contrast, chest X-ray. The colonoscopy was done, and all cases had lesion then biopsy was taken and sent to histopathological study and all results were adenocarcinoma.…”

A novel technique for enterotomy closure in stapled laparoscopic intracorporeal anastomosis

“…Most laparoscopic side‐to‐side anastomoses are performed extracorporeally for technical reasons . However, laparoscopic intracorporeal anastomosis (ICA) has many potential advantages compared with extracorporeal anastomosis: it allows smaller and more flexible incisions for specimen extraction (extraction is usually possible from a mini‐Pfannestiel) with a lower risk of incisional hernia and wound infection, it is less invasive, it facilitates surgery in obese patients and it is associated with a faster recovery and decreased analgesic requirements . Nonetheless we recognize the technical difficulties associated with fashioning an ICA, which necessitates advanced laparoscopic techniques.…”

Reply to Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

“…Hanna et al 5 in their retrospective multicentre study of about 195 patients evaluated both long and short terms outcomes, with a follow-up of 5.7 years, concluding that IA in LRC is associated with similar postoperative and oncologic outcomes compared to EA. Furthermore, IA may overcomes the EA about many advantages in terms of flexibility of specimen extraction, even if it burdened by a higher rate of minor complications (Grade II of Dindo classification).…”