Annals of Coloproctology (Apr 2023)

Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study of anastomotic complications

  • Jonathan Frigault,
  • Samuel Avoine,
  • Sébastien Drolet,
  • François Letarte,
  • Alexandre Bouchard,
  • Jean-Pierre Gagné,
  • Claude Thibault,
  • Roger C. Grégoire,
  • Naomee Jutras Bouthillette,
  • Maude Gosselin,
  • Philippe Bouchard

DOI
https://doi.org/10.3393/ac.2021.00983.0140
Journal volume & issue
Vol. 39, no. 2
pp. 147 – 155

Abstract

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Purpose Laparoscopic right hemicolectomy (LRH) can be performed with an intracorporeal anastomosis (IA) or extracorporeal anastomosis (EA). It is not clear which technique is best. This study evaluated the impact of each anastomosis technique on perioperative safety and postoperative evolution. Methods We performed a retrospective study at a tertiary colorectal surgery center. All patients who had an elective LRH from 2015 to 2019 were analyzed according to the anastomosis technique used. Results In total, 285 patients were included in the study. IA was performed in 64 patients (22.5%). Mean operative time was longer in the patients with IA (IA, 160±31 minutes vs. EA, 138±42 minutes; P0.99), or intraabdominal abscess (IA, 0% vs. EA, 0.5%; P>0.99). During follow-up, we noted more incisional hernias in patients with EA (IA, 1.6% vs. EA, 11.3%; P=0.01) and a trend toward more hernia in patients with EA in multivariate analysis (hazard ratio, 7.13; P=0.06). Anastomosis technique had no influence on recurrence. Conclusion For LRH, both IA and EA are safe, with a low incidence of complications when performed by experienced surgeons. IA may be associated with a lower incidence of incisional hernia.

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