Comparative Study Between Intracorporeal and Extracorporeal Anastomoses in Right Hemicolectomy.

Christopher W Salzmann, MD, Morris E Franklin, MD FACS, Karla Russek, MD, Ulises Garza, MD. Texas Endosurgery Institute

Introduction: The most common technqiues for restoration of intestinal continuity after a laparoscopic right hemicolectomy is an extracorporeal anastomosis, however, an intracorporeal anastomosis is performed routinely by many laparoscopic surgeons. The aim of this paper is to state advantages and disadvantages of an intracorporeal anastomosis compared to an extracorporeal anastomosis, comparing both techniques and with specific focus on complications.

Materials and Methods: We reviewed 473 prospectively studied patients who underwent laparoscopic right hemicolectomy from April 1991 to June 2008 at the Texas Endosurgery Institute. 461 patients were included and 12 excluded because they needed to be converted to open surgery. We compared 123 (54F: 69M) patients who underwent extracorporeal anastomosis with 338 (158F: 180M) patients with intracorporeal anastomosis. The variables are reported with medians and compared using the U test of Mann-Whitney. Categorical data were evaluated using Fisher’s exact test or the Xi-square (χ ²). Statistical significance was defined when the p value was less than 0.05. The odds ratios were estimated with 95% confidence intervals to assess the adjusted value of each dependent variable.

Results: The operative time (161 min vs. 168 min, p = 0.012), surgical bleeding (83 ml vs. 135 ml, p < 0.001), hospital stay (4 vs. 7 days, p < 0.001), perioperative complications (1.2% vs. 4.1%, p= 0.48), minor postoperative complications (7.4% vs 16.3%, p = 0,005) and major postoperative complications rate (2.4% vs. 9.8%, p = 0,001) were lower in the intracorporeal anastomosis group compared to the extracorporeal group. The size of incision (4 vs 6 cm, p <0.001) was lower in the intracorporeal anastomosis group. This had a direct relationship [OR 1.32 CI (0.99-1.78)] in the presence of minor complications, and [OR 1.65 CI (0.11-2.42)] of major complications.

Conclusion: In our experience, the main advantages of doing an intracorporeal anastomosis are the operative time, hospital stay and intraoperative bleeding. Postoperative complications mainly have a direct relationship with the size of the incision for specimen extraction and / or creation of the extracorporeal anastomosis, not the location where the anastomosis is performed.
 

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