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

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

doi:10.3393/ac.2021.00983.0140

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저자정보: Frigault Jonathan (Department of Surgery Laval University Québec) Avoine Samuel (Department of Surgery Laval University Québec) Drolet Sébastien (Department of Surgery Laval University Québec) Letarte François (Department of Surgery Laval University Québec) Bouchard Alexandre (Department of Surgery Laval University Québec) Gagné Jean-Pierre (Department of Surgery Laval University Québec) Thibault Claude (Department of Surgery Laval University Québec) Grégoire Roger C. (Department of Surgery Laval University Québec) Bouthillette Naomee Jutras (Department of Surgery Laval University Québec) Gosselin Maude (Department of Surgery Laval University Québec) Bouchard Philippe (Department of Surgery Laval University Québec)

저널정보: 대한대장항문학회 Annals of Coloproctology Annals of Coloproctolgy Vol.39 No.2

발행연도: 2023.4

수록면: 147 - 155 (9page)

DOI: 10.3393/ac.2021.00983.0140

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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; P<0.001). No differences were observed in intraoperative complications, time to first bowel movement, length of stay, reoperation, or rehospitalization. Time to first flatus was longer in the patients with IA (P=0.049). At 30 days after surgery, there were no differences in the frequency of anastomotic leak (IA, 0% vs. EA, 2.3%; P=0.59), bleeding (IA, 3.1% vs. EA, 2.7%; P>0.99), 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.

#Surgical anastomosis #Colectomy

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