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Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: results from the CLIMHET study group

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Abstract

Background

Laparoscopic right hemicolectomy (LRHC) is increasingly performed for the treatment of right colon disease. Nevertheless, standardization of the surgical technique regarding the performance of intracorporeal (IC) or extracorporeal (EC) anastomosis is lacking. The purpose of this study was to compare short-term postoperative outcomes in patients who had laparoscopic right colectomy either with IC or EC.

Methods

This was a retrospective, non-randomized and multicenter study conducted from January 2005 to December 2015 on the CLIMHET study group cohort from five tertiary centers in France. Data were collected for all patients with LRHC to compare patient characteristics, intraoperative data and postoperative outcomes in terms of medical and surgical complications, duration of hospitalization and mortality. A multivariate analysis was performed to compare the results in the two groups.

Results

Of the 597 patients undergoing LRHC, 150 had IC and 447 had EC. The incidence of medical complications (cardiac, vascular, and pulmonary complications) was lower in the IC group than in the EC group (13 vs 20%, p = 0.049). This difference remained significant in multivariate analysis after adjusting to field characteristics and patient histories (p = 0.009). Additionally, a shorter hospital stay (7 vs 8 days, p = 0.003) was observed in the IC group as compared to the EC group. This difference remained significant in favor of the IC group in multivariate analysis (p = 0.029). There was no difference between the groups as regards: surgical complications (p = 0.76), time of mobilization (p = 0.93), reintervention rate (p = 1) and 90-day mortality (p = 0.47).

Conclusions

Our results show that IC anastomosis in LRHC is associated with fewer medical complications and shorter hospital stays compared to EC anastomosis.

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Authors and Affiliations

  1. Department of Digestive Surgery, Service de Chirurgie Digestive Et Hépato-Biliaire, CHU Estaing, 2, Place Lucie Aubrac, 63000, Clermont-Ferrand, France

    N. Bou Saleh, J. Gagnière, D. Pezet & B. Le Roy

  2. Department of Emergency and Organ Transplantation, Azienda Ospedaliero-Universitaria, Bari, Italy

    I. Franco & R. Memeo

  3. Hepato-Biliary and Pancreatic Surgical Unit, IRCAD-IHU, University of Strasbourg, Strasbourg, France

    I. Franco, D. Mutter & R. Memeo

  4. Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri-Mondor Hospital, AP-HP, Créteil, France

    N. De’Angelis & F. Brunetti

  5. Biostatistics Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France

    F. Canoui-Poitrine

  6. CEpiA EA7376, DHU Ageing-Thorax-Vessel-Blood, Université Paris Est (UPEC), Créteil, France

    F. Canoui-Poitrine

  7. Clinical Research and Innovation Delegation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France

    B. Pereira

  8. Department of Digestive Surgery, Georges Pompidou European Hospital, Paris, France

    T. Voron

  9. Medical Department, Emile Roux Hospital, Puy-en-Velay, France

    B. Monange

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  1. N. Bou Saleh
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  2. T. Voron
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  3. N. De’Angelis
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  4. I. Franco
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  5. F. Canoui-Poitrine
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  6. D. Mutter
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  7. F. Brunetti
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  8. J. Gagnière
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  9. R. Memeo
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  10. D. Pezet
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  11. B. Monange
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  12. B. Pereira
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  13. B. Le Roy
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Correspondence to B. Le Roy.

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Bou Saleh, N., Voron, T., De’Angelis, N. et al. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: results from the CLIMHET study group. Tech Coloproctol 24, 585–592 (2020). https://doi.org/10.1007/s10151-020-02202-z

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  • DOI: https://doi.org/10.1007/s10151-020-02202-z

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