Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay

Abstract

Reconstruction after laparoscopic right colectomy (LRC) can be achieved by performing an intracorporeal (IA) or an extracorporeal anastomosis (EA). This study aims to assess the safety of implementing IA in LRC, and to compare its perioperative outcomes with EA during an institution’s learning curve. Patients undergoing elective LRC with IA or EA in a teaching university hospital between January 2015 and December 2018 were included. Demographic, clinical, perioperative and histopathological data were collated and outcomes investigated. One hundred and twenty-two patients were included; forty-three (35.2%) had an IA. The main indication for surgery was cancer in both groups (83.7% for IA and 79.8% for EA; p = 0.50). Operative time was longer for IA (180 [150–205] versus 150 [120–180] minutes; p < 0.001). A Pfannenstiel incision was used as extraction site in 97.7% of patients receiving an IA; while a midline incision was used in 97.5% of patients having an EA (p < 0.001). Hospital stay was significantly shorter for IA (3 [3, 4] versus 4 [3–6] days; p = 0.003). There were no differences in postoperative complications rates between groups. There was a 4.7% and 3.8% anastomotic leak rate in the IA and EA group, respectively (p = 1). Re-intervention and readmission rates were similar between groups, and there was no mortality during the study period. The implementation of IA in LRC is safe. Despite longer operative times, IA is associated with a shorter hospital stay when compared to EA in the setting of an institution’s learning curve.

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Datasets are available upon editors’ request.

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Acknowledgements

We would like to thank Mr Peadar S. Waters for language editing and reviewing the manuscript

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Contributions

MEM, RM, GU, FC, FB and JTL were the surgeons involved in the cases. CJ, LC, JJG and JTL collected data and drafted the manuscript. All authors contributed to the final version of the manuscript. All authors read the final manuscript and approved the revised final version.

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Correspondence to José Tomás Larach.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Jarry, C., Cárcamo, L., González, J.J. et al. Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay. Updates Surg 73, 93–100 (2021). https://doi.org/10.1007/s13304-020-00840-4

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Keywords

  • Intracorporeal anastomosis
  • Laparoscopic right colectomy
  • Right hemicolectomy
  • Implementation
  • Learning curve