Totally Laparoscopic Right Hemicolectomy with Intracorporeal Anastamosis

Introduction: Laparoscopic right colonic resections has been performed with comparable results to open colectomies. Laparoscopic assisted approach, utilizing an access incision for ileocolic anastamosis is commonly performed for laparoscopic right colectomies. We report our right colon resections experience, using a totally laparoscopic approach utilizing an intracorporeal anastamosis.

Methods: Fiftynine patients underwent a laparoscopic right colectomy with totally intracorporeal anastamosis from August 1996 to November 2007. Retrospective data were collected and analyzed including: age, sex, indication for surgery, procedure performed, operative time, complications, length of stay, pathology, number of nodes, and length of disease-free follow-up.

Results: Of 59 patients, 32 were female (54.2 %), with an age range of 27 to 88 years (mean age 59). Operative indications included colonic polyps in 33, adenocarcinoma in 24, and diverticular/inflammatory disease in 2 patients. The average number of lymph nodes in carcinoma specimens were 17.3 (range 2 to 39). Average OR time was 277 minutes (range 111 to 473 minutes). The median and mean lengths of stay were 4 and 5 days respectively (range 2 to 18). Mean follow up for all patients was 16 months, and for the carcinoma cases it averaged to 24 months. There were three intraoperative complications and no mortality. Long-term complications included 5 extraction site hernias (8.8%) and 4 small bowel obstructions. There were three intraabdominal carcinoma recurrences (5%), but no port site or wound recurrence.

Conclusions: Laparoscopic right colon resection with intracorporeal anastamosis is technically feasible for both benign and. Advantages of totally intracorporeal anastamosis includes the avoidance of malignant diseases extensive colonic mobilization, usually required for extracorporeal anastamosis, smaller incision for specimen extraction, particularly in obese patients with thicker abdominal wall and reduced risk of mesenteric hematoma due to excessive traction on shortened mesentery. Furthermore, future molecular cancer staging may even negate the need of a larger incision for the intact specimen extraction, thus theoretically decreasing postoperative discomfort and hernias.

Session: Poster

Program Number: P157