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Surgical Endoscopy

, Volume 34, Issue 2, pp 557–563 | Cite as

Fashioning enterotomy closure after totally laparoscopic ileocolic anastomosis for right colon cancer: a multicenter experience

  • M. MiloneEmail author
  • U. Elmore
  • M. E. Allaix
  • P. P. Bianchi
  • A. Biondi
  • L. Boni
  • U. Bracale
  • E. Cassinotti
  • G. Ceccarelli
  • F. Corcione
  • D. Cuccurullo
  • M. Degiuli
  • Nicolò De Manzini
  • D. D’Ugo
  • G. Formisano
  • M. Manigrasso
  • M. Morino
  • S. Palmisano
  • R. Persiani
  • R. Reddavid
  • F. Rondelli
  • N. Velotti
  • R. Rosati
  • Giovanni Domenico De Palma
Article

Abstract

Background

Laparoscopic right hemicolectomy is a commonly performed procedure. Little is known on how to perform the enterotomy closure after stapled side-to-side intracorporeal anastomosis.

Method

A multicentric case-controlled study has been designed to compare different ways to fashion enterotomy closure: double layer versus single layer, sewn versus stapled, and robotic versus laparoscopic approach. Furthermore, additional characteristics including sutures’ materials, interrupted versus running suture and the presence of deep corner suture has been investigated.

Results

We collected data for 1092 patients who underwent right hemicolectomy at ten centers. We analyzed 176 robotic against 916 laparoscopic anastomosis: no significant differences were found in terms of bleedings (p = 0.455) and anastomotic leak (p = 0.405). We collected data from 126 laparoscopic sewn single-layer versus 641 laparoscopic sewn double-layer anastomosis: a significant reduction was recorded in terms of leaks in double-layer group (p = 0.02). About double-layer characteristics, we found a significant reduction of bleedings (p = 0.008) and leaks (p = 0.017) with a running suture; similarly, a reduction of bleedings (p = 0.001) and leaks (p = 0.005) was observed with the usage of deep corner closure. The presence of a barbed suture thread seemed to significantly reduce both bleedings (p = 0.001) and leaks (p = 0.001). We found no significant differences in terms of bleedings (p = 0.245) and anastomotic leak (p = 0.660) comparing sewn versus stapled anastomosis.

Conclusions

Fashioning a stapled ileocolic intracorporeal anastomosis, we can recommend the adoption of a double-layer enterotomy closure using a running barbed suture in the first layer. Totally, stapled closure and robotic assistance have to be considered a non-inferior alternative.

Keywords

Enterotomy closure Laparoscopic colectomy Right colon cancer 

Notes

Compliance with ethical standards

Disclosure

M. Milone, U. Elmore, M.E. Allaix, P.P. Bianchi, A. Biondi, L. Boni, U. Bracale, E. Cassinotti, G. Ceccarelli, F. Corcione, D. Cuccurullo, M. Degiuli, Nicolò De Manzini, D. D’Ugo, G. Formisano, M. Manigrasso, M. Morino, S. Palmisano, R. Persiani, R. Reddavid, F. Rondelli, N. Velotti, R. Rosati, and Giovanni Domenico De Palma have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • M. Milone
    • 1
    Email author
  • U. Elmore
    • 2
  • M. E. Allaix
    • 3
  • P. P. Bianchi
    • 4
  • A. Biondi
    • 5
  • L. Boni
    • 6
  • U. Bracale
    • 1
  • E. Cassinotti
    • 6
  • G. Ceccarelli
    • 7
  • F. Corcione
    • 8
  • D. Cuccurullo
    • 8
  • M. Degiuli
    • 9
  • Nicolò De Manzini
    • 10
  • D. D’Ugo
    • 5
  • G. Formisano
    • 4
  • M. Manigrasso
    • 1
  • M. Morino
    • 3
  • S. Palmisano
    • 10
  • R. Persiani
    • 5
  • R. Reddavid
    • 9
  • F. Rondelli
    • 7
  • N. Velotti
    • 1
  • R. Rosati
    • 2
  • Giovanni Domenico De Palma
    • 1
  1. 1.Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapleItaly
  2. 2.Department of Surgery, San Raffaele Scientific InstituteUniversity Vita SaluteMilanItaly
  3. 3.Department of Surgical SciencesUniversity of TurinTurinItaly
  4. 4.Department of General and Minimally-Invasive SurgeryMisericordia HospitalGrossetoItaly
  5. 5.Polo Scienze Gastroenterologiche ed Endocrino-MetabolicheUniversità Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Largo F. VitoRomeItaly
  6. 6.Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico HospitalUniversity of MilanMilanItaly
  7. 7.Department of General Surgery, “San Giovanni Battista” HospitalUSL Umbria 2PerugiaItaly
  8. 8.Azienda Ospedaliera Dei Colli, Monaldi HospitalNaplesItaly
  9. 9.Department of Oncology, Surgical Oncology and Digestive SurgerySan Luigi University Hospital (S.L.U.H.)TurinItaly
  10. 10.Operative Unit of General SurgeryUniversity of TriesteTriesteItaly

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