Advertisement

Surgical Endoscopy

, Volume 30, Issue 9, pp 3823–3829 | Cite as

Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis

  • Ron ShapiroEmail author
  • Uri Keler
  • Lior Segev
  • Stav Sarna
  • Kamal Hatib
  • David Hazzan
Article

Abstract

Background

Laparoscopic right colectomy 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

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.

Results

Patient demographics and disease-related characteristics were similar. Mean operative time was longer in the intracorporeal group (155 vs. 142 min; 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 postoperative 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.

Keywords

Intracorporeal anastomosis Laparoscopic right colectomy Incisional hernia 

Notes

Compliance with ethical standards

Disclosure

Drs. Ron Shapiro, Uri Keler, Lior Segev, Stav Sarna, Kamal Hatib and David Hazzan have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8(5):375–388CrossRefPubMedGoogle Scholar
  2. 2.
    Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev (2):CD003432Google Scholar
  3. 3.
    Duepree HJ, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 197(2):177–181CrossRefPubMedGoogle Scholar
  4. 4.
    Ihedioha U, Mackay G, Leung E, Molloy RG, O’Dwyer PJ (2008) Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 22(3):689–692CrossRefPubMedGoogle Scholar
  5. 5.
    Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143(8):762–767CrossRefPubMedGoogle Scholar
  6. 6.
    Grams J, Tong W, Greenstein AJ, Salky B (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891CrossRefPubMedGoogle Scholar
  7. 7.
    Fabozzi M, Allieta R, Brachet Contul R, Grivon M, Millo P, Lale-Murix E, Nardi M Jr (2010) Comparison of short- and medium-term results between laparoscopically assisted and totally laparoscopic right hemicolectomy: a case-control study. Surg Endosc 24:2085–2091CrossRefPubMedGoogle Scholar
  8. 8.
    Scatizzi M, Kröning KC, Borrelli A, Andan G, Lenzi E, Feroci F (2010) Extracorporeal Versus Intracorporeal Anastomosis after Laparoscopic Right Colectomy for Cancer: a Case-Control Study. World J Surg 34:2902–2908CrossRefPubMedGoogle Scholar
  9. 9.
    Lee KH, Ho J, Akmal Y, Nelson R, Pigazzi A (2013) Short- and long-term outcomes of intracorporeal versus extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for colon cancer. Surg Endosc 27:1986–1990CrossRefPubMedGoogle Scholar
  10. 10.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. Ann Surg 240(2):205–213CrossRefGoogle Scholar
  12. 12.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726CrossRefPubMedGoogle Scholar
  13. 13.
    Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52CrossRefPubMedGoogle Scholar
  14. 14.
    Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20(3):CD003145Google Scholar
  15. 15.
    Singh R, Omiccioli A, Hegge S, McKinley C (2008) Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endosc 22(12):2596–2600CrossRefPubMedGoogle Scholar
  16. 16.
    Llaguna OH, Avgerinos DV, Lugo JZ, Matatov T, Abbadessa B, Martz JE, Leitman IM (2010) Incidence and risk factors for the development of incisional hernia following elective laparoscopic versus open colon resections. Am J Surg 200(2):265–269CrossRefPubMedGoogle Scholar
  17. 17.
    DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H (2011) Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc 25(4):1031–1036CrossRefPubMedGoogle Scholar
  18. 18.
    Bartels SA, Vlug MS, Hollmann MW, Dijkgraaf MG, Ubbink DT, Cense HA, van Wagensveld BA, Engel AF, Gerhards MF, Bemelman WA, Collaborative LAFA Study Group (2014) Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study). Br J Surg 101(9):1153–1159CrossRefPubMedGoogle Scholar
  19. 19.
    Kisielinski K, Conze J, Murken AH, Lenzen NN, Klinge U, Schumpelick V (2004) The Pfannenstiel or so called “bikini cut”: still effective more than 100 years after first description. Hernia 8(3):177–181CrossRefPubMedGoogle Scholar
  20. 20.
    Hoer J, Lawong G, Klinge U, Schumpelick V (2002) Factors influencing the development of incisional hernia. A retrospective study of 2983 laparotomy patients over a period of 10 years. Chirurg 73:474–480CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ron Shapiro
    • 1
    Email author
  • Uri Keler
    • 1
  • Lior Segev
    • 1
  • Stav Sarna
    • 2
  • Kamal Hatib
    • 2
  • David Hazzan
    • 2
  1. 1.Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael
  2. 2.Department of Surgery B, Carmel Medical Center, Affiliated with Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael

Personalised recommendations