Short-term outcomes following intracorporeal versus extracorporeal anastomosis after laparoscopic right and left-sided colectomy: a propensity score-matched study

Abstract

Background: To compare the short-term outcomes of patients undergoing intracorporeal anastomosis (IA) during laparoscopic colectomy to those undergoing extracorporeal anastomosis (EA). Methods and materials: The study was a single-centre retrospective propensity score-matched analysis conducted. Consecutive patients who underwent elective laparoscopic colectomy without the double stapling technique between January 2018 and June 2021 were investigated. The main outcome was overall postoperative complications within 30 days after the procedure. The authors also performed a sub-analysis of the postoperative results of ileocolic anastomosis and colocolic anastomosis, respectively. Results: A total of 283 patients were initially extracted; after propensity score matching, there were 113 patients in each of the IA and EA groups. There were no differences in patient characteristics between the two groups. The IA group had a significantly longer operative time than the EA group (208 vs. 183 min, P=0.001). The rate of overall postoperative complications was significantly lower in the IA group (n=18, 15.9%) than in the EA group (n=34, 30.1%; P=0.02), especially in colocolic anastomosis after left-sided colectomy (IA: 23.8% vs. EA: 59.1%; P=0.03). Postoperative inflammatory marker levels were significantly higher in the IA group on postoperative day 1 but not on postoperative day 7. There was no difference in the postoperative lengths of hospital stay between the two groups, and no deaths occurred. Conclusion: The data suggest that performing IA during laparoscopic colectomy can potentially reduce the risk of postoperative complications, especially in colocolic anastomosis after left-sided colectomy.

Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis

“…Previous studies have not reported a reduction in operative time. Some reports indicate that IA and EA are comparable in terms of operative time[ 13 ], but in most reports, IA is longer than EA[ 14 , 15 ], and this applies to robotic surgery[ 16 , 17 ]. On the other hand, the amount of bleeding was significantly lower in IA.…”

Stapler size independently predicts postoperative complications following stapled ileocolic anastomosis: A retrospective cohort study

“…The main limitations of our study include being a retrospective single-centre, non-randomized study and during a period in which there were other intervening factors such as the use of three rows of staples and intelligent sealing. Almost all anastomoses were extracorporeal, which did not allow for further analysis of predictors of complications based on the type and method of anastomosis as intracorporeal anastomosis was found to be associated with lower rates of complications [20][21][22]. The numbers included are relatively small yet were sufficient to obtain significant results in the multivariate analysis.…”

Minimally Invasive Left Colectomy with Total Intracorporeal Anastomosis versus Extracorporeal Anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation

“…The same applies to operating time: IA is associated with a longer surgical time in most comparative studies, though the difference is not always signi cant. [32] Comparing laparoscopic and robotic approaches, recent studies show the robotic approach entails extended surgery time and higher costs [20][21][22]. However, systematic reviews and meta-analyses reveal lower rates of overall morbidity, anastomotic dehiscence, and SSIs (super cial and deep) in robotic surgery [19,20].…”

“…In terms of comparisons with the laparoscopic approach, there are few but promising ndings for R-TIA. [25][26][27][28][29][30][31][32][33].…”