Abstract
Introduction: Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Objective: To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis. Patients and Method: Analytical observational study, with defined inclusion and exclusion criteria. The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data. Data analysis with STATA 13.0. Results: 216 patients with ileocolic anastomosis, highlighting statistical significance when crossing: A) reoperation and type of suture (p = 0.044), with UN or 3.4 (95% CI 0.94 to 18.6), being of greater risk the mechanics; B) mortality and urgency (p = 0.001) with an OR 7.76 (95% CI 1.56-49.29), with emergency surgery being of greater risk. Isoperistaltic anastomosis with gas elimination (p < 0.001), intestinal transit (p = 0.009) and solid intake (p = 0.005) earlier. There is earlier expulsion of gases in the laparoscopic approach, manual suture, end-to-side and isoperistaltic of the anastomosis and elective surgery. Conclusion: There is great variability of techniques to perform the ileocolic anastomosis. Manual anastomosis is less likely to require surgical reoperation, elective surgery has a lower mortality than that of emergency surgery. We suggest performing it laparoscopically, with manual suture, lateral term, isoperistaltic and electively, for having a shorter recovery.
Highlights
Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it
To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis
The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data
Summary
Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Los resultados referentes a técnica quirúrgica y configuración anastomótica se revelan en la Tabla 3, destacando que el abordaje abierto fue el de elección en el 58% de los pacientes, con sutura mecánica en un 66%, latero-lateral (LL) en el 80%, anisoperistáltica en el 71,3%, con confección de anastomosis extracorpórea en el 82% de las cirugías laparoscópicas no convertidas y el tipo de cirugía fue electiva en el 78,2% de los pacientes. Al cruzar las variables (Tabla 3) técnica quirúrgica y configuración anastomótica con aquellas definidas como resultado en la Tabla 1, destacan con significancia estadística las siguientes variables: 1) Reoperación y el tipo de sutura (p = 0,044), con un 2,7% (2/74) para anastomosis manual y un 13,4% (19/142) para anastomosis mecánica con un OR 3,4 (IC 95% 0,94-18,6), siendo de mayor riesgo
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