Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastamosis: a comparison of short-term outcomes

Vergis, Ashley; Steigerwald, S.; Bhojani, Faizal D.; Sullivan, Paul A.; Hardy, Krista

doi:10.1503/cjs.001914

Cited by 50 publications

(42 citation statements)

References 24 publications

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“…In the present series, although an earlier recovery of gas and bowel function was reported in the IA group, the 2 groups experienced a similar length of stay and incidence of postoperative ileus. These results are in line with the experience of the majority of authors who have analyzed the outcome of IA vs. EA in the nonobese population [4,5,14,15,25] and with our recent interim analysis of a Randomized Controlled Trial on the same subject [12]. In the aforementioned study, a similar length of stay was reported in the 2 groups, despite an earlier recovery of bowel function, and a lower incidence of postoperative ileus was observed in the IA.…”

Section: Discussionsupporting

confidence: 89%

Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

Vignali¹,

Elmore²,

Lemma³

et al. 2017

Dig Surg

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Background/Aims: To compare short- and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) in obese (body mass index >30 kg/m²) patients. Patients and Methods: Sixty-four consecutive obese patients who underwent laparoscopic (LPS) right colectomy with IA were matched with 64 patients who underwent LPS right colectomy with EA. Intraoperative variables, short-term outcomes, readmission rates, and morbidity and mortality rates were analyzed along with long-term outcomes. Results: Conversion to open surgery occurred in 4 patients in the IA group and 11 patients in the EA group (p = 0.097). The overall 30-day morbidity rate was 29.6% in the IA and 32.8% in the EA (p = 0.70). No 30-day mortality occurred. Anastomotic leak occurred in 4.7% of patients in the IA group vs. 7.8% in the EA group (p = 0.71). In the IA group, an earlier recovery of bowel function was observed (p = 0.01). No differences were observed with respect to the length of stay and reoperation rate. No 30-day readmission occurred in the IA compared to 5 patients readmitted in the EA group (p = 0.058). A higher incidence of incisional hernia was observed in the EA group (p = 0.033). Conclusion: IA in obese patients is associated with similar short-term outcomes, lower incidence of incisional hernias, and might possibly reduce the risk of hospital readmission.

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Section: Discussionsupporting

confidence: 89%

Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

Vignali¹,

Elmore²,

Lemma³

et al. 2017

Dig Surg

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“…1. Finally, 12 studies were incorporated in the qualitative analysis [13–19, 32–36]. For studies with overlap, we included the most recent publications which consisted of more patients [13, 36] and excluded the earlier studies [9, 23].…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies were of retrospective design [13, 15–19, 32–36]. Milone et al [16] matched the control group using a propensity score.…”

Section: Resultsmentioning

confidence: 99%

“…In nine studies, the intracorporeal performed anastomosis was created using a mechanical stapler with [13–15, 17–19, 33, 35, 36] or without [16] additional sutures in the IA technique. A mechanical stapler was most commonly used for the extracorporeal anastomosis as well (with [13, 14, 18, 36] or without [16, 19] additional sutures). One study made a hand-sewn anastomosis [15] or according to the preference of the individual surgeon (mechanical or hand-sewn) [17, 33].…”

Section: Resultsmentioning

confidence: 99%

“…Despite potential benefits of the intracorporeal technique, previous reviews published in 2013 failed to show clear advantages of the newer technique [11, 12]. Since the more recently published studies [13–19] show benefits in short-term morbidity and shorter length of stay for the IA technique, we have conducted an up-to-date systematic review with the most recent studies to investigate the value of the intracorporeal anastomotic technique for laparoscopic right hemicolectomy. We hypothesized that an intracorporeal performed anastomosis leads to a decrease in short morbidity resulting in a shorter length of stay.…”

Section: Introductionmentioning

confidence: 99%

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Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis

et al. 2016

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BackgroundLaparoscopic right hemicolectomy for colon cancer is associated with substantial morbidity despite the introduction of enhanced recovery protocols and laparoscopic surgery. Laparoscopic right hemicolectomy with an intracorporeal anastomosis (IA) is less invasive than laparoscopic assisted hemicolectomy, possibly leading to further decrease in post-operative morbidity and faster recovery. The current standard technique includes an extracorporeal anastomosis with mobilization of the colon, mesenteric traction and a extraction wound located in the mid/upper abdomen with relative more post-operative morbidity compared to extraction wounds located in the lower abdomen.MethodsA systematic review of PubMed and Embase databases was performed on studies comparing the intracorporeal versus the extracorporeal performed anastomosis in laparoscopic right hemicolectomy. Primary outcomes were mortality, short-term morbidity and length of stay. For quality assessment, the MINORS checklist was used. Meta-analysis was performed using a random-effects model, and a subgroup analysis was performed for data regarding short-term morbidity and length of stay in studies published in 2012≥.ResultsA total of 2692 papers were identified, 12 non-randomized comparative studies were included in the analysis with a total number of 1492 patients. No significant change in mortality was found (OR 0.36, 95 % CI 0.09–1.46; I 2 = 0 %). Short-term morbidity decreased significantly in favour of IA (OR 0.68, 95 % CI 0.49–0.93; I 2 = 20 %). Length of stay was decreased, but with serious risk of heterogeneity (MD −0.77 days, 95 % CI −1.46 to −0.07; I 2 = 81 %). Subgroup analysis for papers published in 2012≥ resulted in an even larger decrease in short-term morbidity (OR 0.65, 95 % CI 0.50–0.85; I 2 = 0 %) and a significant decrease in length of stay with low risk of heterogeneity (MD −0.77 days, 95 % CI −1.17 to −0.37; I 2 = 4 %).ConclusionIntracorporeal anastomosis in laparoscopic right hemicolectomy is associated with reduced short-term morbidity and decreased length of hospital stay suggesting faster recovery as shown in this meta-analysis.

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Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial)

Bollo

Turrado

Fueyo

et al. 2020

Journal of British Surgery

126

132

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Background Several non‐randomized and retrospective studies have suggested that intracorporeal anastomosis (IA) has advantages over extracorporeal anastomosis (EA) in laparoscopic right colectomy, but scientific evidence is lacking. The aim was to compare short‐term outcomes and to define the possible benefits of IA compared with EA in elective laparoscopic right colectomy. Methods An RCT was conducted from May 2015 to June 2018. The primary endpoint was duration of hospital stay. Secondary endpoints were intraoperative technical events and postoperative clinical outcomes. Results A total of 140 patients were randomized. Duration of surgery was longer for procedures with an IA than in those with an EA (median 149 (range 95–215) versus 123 (60–240) min; P < 0·001). Wound length was shorter in the IA group (median 6·7 (4–9·5) versus 8·7 (5–13) cm; P < 0·001). Digestive function recovered earlier in patients with an IA (median 2·3 versus 3·3 days; P = 0·003) and the incidence of paralytic ileus was lower (13 versus 30 per cent; P = 0·022). Less postoperative analgesia was needed in the IA group (mean(s.d.) weighted analgesia requirement 39(24) versus 53(26); P = 0·001) and the pain score was also lower (P = 0·035). The postoperative decrease in haemoglobin level was smaller (mean(s.d.) 8·8(1·7) versus 17·1(1·7) mg/dl; P = 0·001) and there was less lower gastrointestinal bleeding (3 versus 14 per cent; P = 0·031) in the IA group. IA was associated with a significantly better rate of grade I and II complications (P = 0·016 and P = 0·037 respectively). The duration of hospital stay was slightly shorter in the IA group (median 5·7 (range 2–19) versus 6·6 (2–23) days; P = 0·194). Conclusion Duration of hospital stay was similar, but IA was associated with less pain and fewer complications. Registration number: NCT02667860 ( http://www.clinicaltrials.gov).

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Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastamosis: a comparison of short-term outcomes

Cited by 50 publications

References 24 publications

Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis

Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial)

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