Maude Trepanier, Anthony Valin-Thorburn, Teodora Dumitra, Mohsen Alhashemi, Nicolo Pecorelli, Pepa Kaneva, A. Sender Liberman, Patrick Charlebois, Barry L Stein, Liane S Feldman, Lawrence Lee. McGill University Health Center
Introduction: Delayed gastrointestinal(GI) recovery remains a significant morbidity after colorectal surgery, even within an Enhanced Recovery After Surgery(ERAS) program. It is hypothesized that intracorporeal anastomosis for right colectomy may hasten GI recovery. Therefore, the objective of this study was to determine the effect of intracorporeal versus extracorporeal anastomosis on GI recovery after elective laparoscopic right colectomy within an established ERAS program.
Methods: Adult patients undergoing elective laparoscopic right hemicolectomy or ileocecal resection at a single high volume specialist referral institution from 2014-2018 were reviewed. Patients were divided into two groups based on method of anastomotic creation: intracorporeal(IC) and extracorporeal(EC). The main outcome was GI-3 recovery defined as time to tolerance of solid diet and first flatus or bowel movement. Prolonged postoperative ileus (PPOI) was defined as GI-3 not met by postoperative day 4. Secondary outcomes were length of stay(LOS) and overall 30-day complications, including anastomotic leaks and superficial surgical site infections(SSI). Coarsened exact matching was performed to create balanced cohorts for comparison using age, gender, American Society of Anesthesiologists (ASA) physical status, body mass index (BMI), and diagnosis. Multiple regression was performed using a Cox proportional hazard model to identify predictors of GI recovery.
Results: A total of 228 patients were included (49 IC, 179 EC). The matched cohort included 183 patients (43 IC, 140 EC). Patient characteristics were well balanced between matched groups: mean age was 66.7 years (SD14.7), BMI was 26.0 (SD5.5), median ASA was 2 (IQR2-3) and 67.7% of patients underwent surgery for malignancy. IC anastomosis was associated with lower blood loss (77ml (SD82.5) vs. 116ml (SD104.2), p=0.013) but longer operative duration longer (171min (SD42) vs. 145min (SD40), p<0.001). There was no difference in the median time to GI-3 recovery (IC 2 days [IQR1-3] vs. EC 2 days [IQR2-2] p=0.399). The incidence of PPOI (IC 10.0% vs. EC 8.4%, p=0.574), superficial SSI (7.0% vs. 3.6%, p=0.282), deep SSI (2.3% vs. 3.6%, p=0.569) and median LOS (3 days [IQR2-4] vs. 3 days [IQR3-4], p=0.700) were also similar. On multivariate analysis, IC anastomosis was not independently associated with faster gastrointestinal recovery (HR 0.86, 95%CI 0.58-1.28).
Conclusion: IC anastomosis was not associated with faster GI recovery or reduced complication rate compared to EC anastomosis in patients undergoing laparoscopic right colectomy within an established ERAS program. Longer term studies may be required to determine the potential benefits of IC anastomosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94569
Program Number: S038
Presentation Session: Colorectal I
Presentation Type: Podium