Laparoscopic Right Hemicolectomy with Intracorporal Versus Extracorporal Anastamosis: A Comparison of Short-Term Outcomes

Krista Hardy, MD MSc, Ashley Vergis, MD MMedEd, Paul Sullivan, MD. University of Manitoba, Manitoba, Canada; University of Toronto, Ontario, Canada

Introduction: The objective of the study was to compare the short-term outcomes of laparoscopic right hemicolectomy with intracorporal versus extracorporal anastamosis.

Methods and Procedures: A retrospective review of all elective laparoscopic right hemicolectomies at St. Joseph’s Hospital, Ontario from January 2008 to September 2009 was undertaken. Patient demographic, pathologic, operative and outcome data was recorded. Data was analyzed using the Student’s t-test for continuous variables and the Pearson chi-squared test for categorical variables. Median length of stay was assessed with the Mann-Whitney U test. Institutional ethics review board approval was obtained.

Results: Fifty elective laparoscopic right hemicolectomies were completed during the study period, including 21 intracorporal and 29 extracorporal anastamoses. The groups were similar in terms of age, gender, body mass index, ASA score, previous laparotomy and preoperative invasive pathology. There was no difference in mean operative time (217 vs 196 min, p=NS), estimated blood loss (14 vs 42 cc, p=NS), perioperative blood transfusions (5% vs 14%, p=NS), in-hospital morbidity (33% vs 41%, p=NS), out-of-hospital morbidity (19% vs 31%, p=NS), emergency department visits (10% vs 17%, p=NS) or 30-day readmissions (5% vs 7%, p=NS) for intracorporal versus extracorporal anastamoses, respectively. There was one anastamotic leak in each group and there were no perioperative deaths. The median length of stay was significantly shorter for intracorporal anastamoses (4 vs 5 days, p=0.05). Two ventral hernias occurred in midline extraction sites with extracorporal anastamoses.

Conclusion: Laparoscopic right hemicolectomy can be performed safely with either an intracorporal or extracorporal anastamosis. While an intracorporal anastamosis requires advanced laparoscopic suturing skills, it has the advantage of a less hernia-prone Pfannenstiel extraction site with faster recovery and reduced length of stay.