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Bowel recovery after intra- vs extra-corporeal anastomosis for oncologic laparoscopic right hemicolectomy within an ERAS protocol: a retrospective study

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Abstract

Objective

Restoring bowel continuity after laparoscopic right hemicolectomy with an intra-corporeal (IC) rather than an extra-corporeal (EC) ileocolic anastomosis may offer advantages in post-operative recovery. The aim of this study was to compare bowel function recovery between these two techniques, in a context of complete mesocolic excision within an enhanced recovery after surgery (ERAS) protocol.

Methods

All consecutive patients who underwent oncologic laparoscopic right hemicolectomy from January 2012 to February 2021 in our institution were included in the study. Data were gathered from the prospectively maintained official ERAS (EIAS) database and completed through our institution’s electronic health records. The primary endpoint was prolonged post-operative ileus (PPOI), defined as the need to insert a nasogastric tube, or refractory nausea VAS > 4, on or after the third post-operative day. Secondary endpoints were post-operative pain, morbidity and length of hospital stay (LoS). Groups were compared before and after propensity score matching based on age, gender, ASA score, use of epidural analgesia and post-operative complications.

Results

A total of 108 patients met the inclusion criteria, 36 (30%) had IC and 72 (70%) EC anastomosis. In the unmatched population, baseline characteristics were similar except for more frequent use of epidural analgesia in the EC group (62 (72.9%) vs. 17 (47.2), p = 0.007). PSM analysis was carried out. Operative time was longer in the IC group (197 min (176–223) vs. 160 (140–189), p < 0.001). The rate of PPOI was similar (2 (5.6%) patients in the IC group vs. 10 (11.6%) in the EC group (p = 0.306)), but time to frist passage of flatus and stool was shorter in the IC group. There was no difference in morbidity but patients after IC anastomosis had lower pain VAS scores at 24 h (p = 0.004) and a trend for a shorter LoS (6 (5–8) days vs 7 (5–10) in the EC group, p = 0.054). After PSM, there were 36 patients in each group. PPOI, time to first flatus and stool, morbidity and LoS were not significantly different although there was a trend for better recovery outcomes in the IC group. Patients in the IC group had significantly longer operative times but less pain at 24 h.

Conclusions

Although IC anastomosis was not significantly associated to lower rates of PPOI, it showed trends of faster recovery and significantly less post-operative pain at the expense of longer operating times.

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Authors and Affiliations

  1. Department of Surgery, Regional Hospital of Lugano, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland

    S. G. Popeskou, Zs Horvath, F. Mongelli, R. Roesel, A. Cristaudi, F. Garofalo & D. Christoforidis

  2. Department of Visceral Surgery, University Hospital of Lugano (EOC), Via Tesserete 46, 6900, Lugano, Switzerland

    S. G. Popeskou

  3. Department of Surgery, CHUV, University of Lausanne, Lausanne, Switzerland

    D. Christoforidis

Authors
  1. S. G. Popeskou
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  2. Zs Horvath
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  3. F. Mongelli
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  4. R. Roesel
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  5. A. Cristaudi
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  6. F. Garofalo
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Correspondence to S. G. Popeskou.

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Statement of ethics

The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The study was approved by the Swiss Institutional Review Board without the need of written consent from the patients included. The study was conducted according to the STROBE criteria (http://strobe-statement.org/).

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The authors declare no competing interests.

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S G Popeskou and Zs Horvath shared authorship.

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Popeskou, S.G., Horvath, Z., Mongelli, F. et al. Bowel recovery after intra- vs extra-corporeal anastomosis for oncologic laparoscopic right hemicolectomy within an ERAS protocol: a retrospective study. Langenbecks Arch Surg 407, 2463–2469 (2022). https://doi.org/10.1007/s00423-022-02585-7

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  • DOI: https://doi.org/10.1007/s00423-022-02585-7

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