Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy

Minia Hellan, Casandra Anderson, Alessio Pigazzi, Minia Hellan, Casandra Anderson, Alessio Pigazzi

Abstract

Background: During laparoscopic right hemicolectomy, the anastomosis can be created intra- or extracorporeally. This study aimed to determine whether a difference exists in short-term outcomes between these techniques.

Methods: Prospectively collected data of 80 consecutive patients who underwent laparoscopic right hemicolectomies since 2004 were reviewed retrospectively. An intracorporeal anastomosis was performed in 23 patients, an extracorporeal anastomosis in 57.

Results: There were no significant differences in median length of stay (4 days), number of removed lymph nodes, estimated blood loss, operative time (190 minutes intracorporeal vs. 180 minutes) and postoperative ileus (22% intracorporeal vs. 16%). The incision length was significantly shorter in the intracorporeal group (4cm vs. 5cm; P=0.004). Complications related to the anastomosis including twisting of the mesentery (n=2), anastomotic volvulus (n=1), or leak (n=1) occurred in 4 patients in the extracorporeal group compared with one minor anastomotic leak in the intracorporeal group. Major complication rates were similar between the 2 groups (4.3% intracorporeal vs. 5.3% extracorporeal).

Conclusion: The type of anastomosis does not influence short-term outcomes after laparoscopic right hemicolectomy. An intracorporeal anastomosis results in shorter incision length and may decrease wound-related complications.

References

    1. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J. Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg. 2006;93:921–928
    1. Milsom JW, Hammerhofer KA, Bohm B, Marcello P, Elson P, Fazio VW. Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn's disease. Dis Colon Rectum. 2001;44:1–8
    1. Solomon MJ, Young CJ, Eyers AA, Roberts RA. Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg. 2002;89:35–39
    1. The Clinical Outcomes of Surgical Therapy Study Group A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–2059
    1. Baca I, Perko Z, Bokan I, et al. Technique and survival after laparoscopically assisted right hemicolectomy. Surg Endosc. 2005;19:650–655
    1. Ballantyne GH, Leahy PF. Hand-assisted laparoscopic colectomy: evolution to a clinically useful technique. Dis Colon Rectum. 2004;47:753–765
    1. Casciola L, Ceccarelli G, Di Zitti L, et al. Laparoscopic right hemicolectomy with intracorporeal anastomosis. Technical aspects and personal experience [Italian]. Minerva Chir. 2003;58:621–627
    1. Franklin ME, Jr., Gonzalez JJ, Jr., Miter DB, et al. Laparoscopic right hemicolectomy for cancer: 11-year experience. Rev Gastroenterol Mex. 69(suppl 1):65–72, 2004
    1. Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW., Jr Laparoscopic-assisted vs. open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A. 14:329–334, 2004
    1. Leung KL, Meng WC, Lee JF, Thung KH, Lai PB, Lau WY. Laparoscopic-assisted resection of right-sided colonic carcinoma: a case-control study. J Surg Oncol. 1999;71:97–100
    1. Lezoche E, Feliciotti F, Paganini AM, Guerrieri M, De SA, Minervini S, Campagnacci R. Laparoscopic vs open hemicolectomy for colon cancer. Surg Endosc. 2002;16:596–602
    1. Senagore AJ, Delaney CP, Brady KM, Fazio VW. Standardized approach to laparoscopic right colectomy: outcomes in 70 consecutive cases. J Am Coll Surg. 2004;199:675–679
    1. Senagore AJ, Delaney CP. A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases. Am J Surg. 2006;191:377–380
    1. Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH. Laparoscopic Medial-to-lateral Colon Dissection: How and Why. J Gastrointest Surg. 2007;11:778–782
    1. Bernstein MA, Dawson JW, Reissman P, Weiss EG, Nogueras JJ, Wexner SD. Is complete laparoscopic colectomy superior to laparoscopic assisted colectomy? Am Surg. 1996;62:507–511
    1. Raftopoulos I, Courcoulas AP, Blumberg D. Should completely intracorporeal anastomosis be considered in obese patients who undergo laparoscopic colectomy for benign or malignant disease of the colon? Surgery. 2006;40:675–682
    1. Bergamaschi R, Schochet E, Haughn C, Burke M, Reed JF, Arnaud JP. Standardized laparoscopic intracorporeal right colectomy for cancer: short-term outcome in 111 unselected patients. Dis Colon Rectum. 2008;51(9):1350–1355
    1. Young-Fadok TM, Nelson H. Laparoscopic right colectomy: five-step procedure. Dis Colon Rectum. 2000;43:267–271
    1. Pikarsky AJ, Saida Y, Yamaguchi T, et al. Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc. 2002;16:855–858
    1. Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW. Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg. 2003;7:558–561
    1. Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM. Wound complications of laparoscopic vs open colectomy. Surg Endosc. 2002;16:1420–1425
    1. Singh R, Omiccioli A, Hegge S, McKinley C. Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endosc. 2008;22(12):2596–2600
    1. Kisielinski K, Conze J, Murken AH, Lenzen NN, Klinge U, Schumpelick V. The Pfannenstiel as so called “bikini cut”: still effective more than 100 years after first description. Hernia. 2004;8:177–181

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi