Application of overlapped delta-shaped anastomosis technique in totally laparoscopic right hemicolectomy

Abstract

To explore the safety and feasibility of the overlapped delta-shaped anastomosis (ODA) technique for cases undergoing totally laparoscopic right hemicolectomy (TLRH). Clinical data of patients who underwent TLRH using the ODA technique or the modified delta-shaped anastomosis (MDA) technique at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2016 to December 2017 were retrospectively analyzed. (1)diagnosed with adenocarcinoma by enteroscopy before operation; (2)cancer locating at ascending colon or transverse colon hepatic region and receiving TLRH surgery. (1) double or multiple primary colorectal cancers;(2)with complete or incomplete intestinal obstruction; (3) combined multiple organs resection; and (4) with unresectable distant metastases. The ileum and the transverse colon were sutured in an overlapped fashion about 8 cm away from the end of the ileum firstly, and then two small openings locating at the end of ileum and the corresponding site of the transverse colon were created in the ODA procedure, and the two small openings both locating at the end of ileum and the transverse colon were created in the MDA procedure. Statistical analysis was performed using SPSS 24.0 software and the general information, surgical and pathological results, and complications between two groups were compared. A total of 108 patients were enrolled in this study, including 52 patients in the ODA group and 56 patients in the MDA group. In the ODA group, 28 patients were male and 24 were female with age of (53.3±10.0) years and body mass index (BMI) of (24.2±2.7) kg/m2. In the MDA group, 27 patients were male and 29 were female with a mean age of (54.5±9.4) years and body mass index of (23.8±2.4) kg/m2. There were no significant differences between the two groups in terms of age, gender, BMI, history of previous abdominal surgery, scoring of American Society of Anesthesiologists, tumor location, pathological TNM stage, and number of dissected lymph node (all P>0.05). All the patients underwent R0 resection without conversion to open surgery or to extraperitoneal anastomosis. The time of anastomosis in the ODA group was shorter than that in the MDA group[(15.7±2.3) minutes vs.(18.6±3.6) minutes], and the difference was statistically significant (t=-5.017, P<0.001). There were no significant differences between two groups in total operative time[(160.7±17.8) minutes vs.(163.2±17.6) minutes], intraoperative blood loss [(77.7±28.3) ml vs.(75.9±31.8) ml], length of incision [(5.8±1.1) cm vs. (5.9±1.1) cm], time to first flatus [(1.8±0.2) days vs. (1.9±0.3) days], time to first oral intake [(1.9±0.5) days vs. (1.9±0.4) days], postoperative complications [3.8%(2/52) vs. 5.4%(3/56)], and postoperative hospital stay [(6.7±0.9) days vs. (6.8±0.8) days]. The ODA technique is less time-consuming without increasing postoperative complications compared to the MDA technique, which is a safe and feasible technique in TLRH worth further promotion.