Laparoscopic Right Hemicolectomy with Intracorporeal Anastomosis: Short- and Long-term Benefits in Comparison with Extracorporeal Anastomosis

Ron Shapiro, MD¹, Uri Keler, MD¹, Stav Sarna-Cahan, MD², Kamal Hatib, MD², David Hazzan². ¹Chaim Sheba Medical Center, Tel-Hashomer, ²Carmel Medical Center

Introduction – Laparoscopic right hemicolectomy with intracorporeal anastomosis is a procedure of increasing popularity. This study aims to compare short and long term outcomes of intracorporeal and extracorporeal anastomoses

Methods and Procedures  – This is a comparative study of two anastomosis techniques for laparoscopic right hemicolectomy.  A total of 191 consecutive patients, operated for neoplasm of the right colon, were identified. The intracorporeal group included 91 patients and the extracorporeal group 100 patients. Data on patients' demographics, disease related characteristics, operative characteristics, short term outcomes and complications were prospectively recorded. Data on long term outcomes was retrospectively reviewed. T-Test was used for continues variables and Chi square was used for analysis of categorical variables.

Results – Patient demographics and disease related characteristics were similar. Mean operative time was longer in the intracorporeal group (155 vs. 142 minutes; P=0.006). Intracorporeal anastomosis was associated with less overall postoperative complications (18.7% vs. 35%, P=0.011) and decreased rate of Surgical Site Infections (4.4% vs. 14%, P=0.023). The need for post-operative intervention (Clavien-Dindo 3) was higher in the extracorporeal group (7% vs. 0%; P=0.015). There was no statistically significant difference in the incidence of postoperative leak, ileus and bleeding. Mean length of stay was significantly shorter in the intracorporeal group (5.9±2.1 vs.6.9±3.0; P=0.04). Moreover, more patients with intracorporeal anastomosis had a length of stay shorter than 4 days (28.6% vs. 14.1%, P=0.015). Extraction incision was periumbilical in 99% of the patients in the extracorporeal group. In the intracorporeal group extraction incision was transverse suprapubic (Pfannenstiel) in 85.7%, transvaginal in 9.9% and periumbilical in 3.3% of the patients. The incidence rate of incisional hernia was lower in the intracorporeal group (2.2% vs. 17.0%, P=0.001).

Conclusions – Laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short and long term outcomes. The rates of postoperative complications requiring intervention and incisional hernias are decreased