End-to-End hand sewn anastomosis versus side-to-side stapled anastomosis in laparoscopic right colectomy. A prospective randomized controlled trial.

M Bun, MD, A Canelas, MD, F Carballo, MD, E Grzona, MD, M Laporte, MD, C Peczan, MD, N Rotholtz, MD

Colorectal Surgery Division – Hospital Aleman de Buenos Aires. Argentina.

BACKGROUND: The superiority of the different techniques for ileocolic anastomosis is controversial.
Although many trials trying to compare both techniques in right colectomies, there is no publications until today comparing these alternatives using the laparoscopic approach.

Objective: The aim of this study is to compare the outcome of the End-to-end hand sewn anastomosis versus side-to-side stapled anastomosis in patients undergoing laparoscopic right colectomy.

DESIGN: Experimental, randomized controlled trial.

MATERIALS AND METHODS: Patients candidates of laparoscopic right colectomy between January 2006 and May 2012 were included. Patients that required conversion to open surgery; emergency procedures; Crohn’s disease; and surgeries associated with other surgical procedures were excluded. To avoid any bias during colectomy, randomization was performed once completed this stage and proceeded to make the incision for the specimen extraction. Two groups were randomized: End-to-end hand sewn anastomosis (GI) and Side-to-side stapled anastomosis (GII). Surgical time; major and minor complications; reoperation rate; recovery of intestinal function and hospital stay were analyzed. The statistical significance level was defined as p <0.05. Statistical analysis was performed using the statistical software "SPSS 19".

RESULTS: A total of 230 laparoscopic right colectomies were performed in the study period. One hundred fifty three patients met the inclusion criteria. The mean age was 65.6 (23-90) years. Eighty six (56.3%) patients were male. 144 (94%) were operated for malignant disease. After randomization, 74(48.3%) patients belonged to the GI whereas 79 (51.7%) GII. Mean operative time was 127.8 ± 34.7 minutes. There was a tendency for having significantly shorter operative time in GII (GI vs. GII: 146.8 ± 49.47 vs G2: 123.8 ± 34.7, P <0.05). There were no other significant differences between the groups.

CONCLUSIONS: The operative time of laparoscopic right colectomy is lower when a stapled anastomosis is performed without affecting any other postoperative variable.

Session: Podium Presentation

Program Number: S049

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