Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis.

Abstract

Laparoscopic right colectomy with intracorporeal anastomosis is a procedure of increasing popularity. This study aims to compare short- and long-term outcomes of intracorporeal and extracorporeal anastomoses. This is a comparative study of two anastomosis techniques for laparoscopic right hemicolectomy. A total of 191 consecutive patients, operated for neoplasm of the right colon, were identified. The intracorporeal group included 91 patients and the extracorporeal group 100 patients. Patient demographics and disease-related characteristics were similar. Mean operative time was longer in the intracorporeal group (155 vs. 142min; P=0.006). Intracorporeal anastomosis was associated with less overall postoperative complications (18.7 vs. 35%, P=0.011) and decreased rate of surgical site infections (4.4 vs. 14%, P=0.023). The need for postoperative intervention (Clavien-Dindo 3) was higher in the extracorporeal group (7 vs. 0%; P=0.015). There was no statistically significant difference in the incidence of postoperative leak, ileus and bleeding. Mean length of stay was significantly shorter in the intracorporeal group (5.9±2.1 vs. 6.9±3.0; P=0.04). Moreover, more patients with intracorporeal anastomosis had a length of stay shorter than 4days (28.6 vs. 14.1%, P=0.015). Extraction incision was periumbilical in 99% of the patients in the extracorporeal group. In the intracorporeal group extraction, incision was transverse suprapubic (Pfannenstiel) in 85.7%, transvaginal in 9.9% and periumbilical in 3.3% of the patients. The incidence rate of incisional hernia was lower in the intracorporeal group (2.2 vs. 17.0%, P=0.001). Laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short- and long-term outcomes. The rates of postoperative complications requiring intervention and incisional hernias are decreased.