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Meta-analysis of randomised controlled trials comparing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: upgrading the level of evidence

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Abstract

The need for escalation of level of evidence regarding the comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy has been persistently highlighted by previous meta-analyses of level 2 and 3 evidence. A systematic search of electronic databases and bibliographic reference lists were conducted. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, length of incision, conversion to an open procedure, harvested lymph nodes, procedure time, and length of hospital stay were the evaluated outcome parameters. Four randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy were included. The ICA was associated with significantly shorter length of incision (MD − 1.82, p < 0.00001), lower postoperative pain score on day 2 (MD − 0.69, p = 0.0007), day 3 (MD − 0.80, p = 0.02), day 4 (MD − 0.83, p = 0.01) and day 5 (MD − 0.49, p < 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD − 0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR 0.79, p = 0.47), anastomotic leak (RR 1.29, p = 0.65), SSI (RR 0.61, p = 0.42), bleeding (RR 0.70, p = 0.71), paralytic ileus (RR 0.60, p = 0.45), conversion to open (RD: − 0.02, p = 0.45), number of harvested lymph nodes (MD 0.82, p = 0.06), and procedure time (MD 16.04, p = 0.06) between two groups. The meta-analysis of level 1 evidence demonstrated that laparoscopic right hemicolectomy with ICA has comparable perioperative morbidity but better postoperative recovery than with ECA. The ICA is safe to be practiced more routinely where technical challenges allow.

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  1. Shahin Hajibandeh and Shahab Hajibandeh equally contributed to this paper and joined first authorship is proposed.

Authors and Affiliations

  1. Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK

    Shahin Hajibandeh

  2. Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK

    Shahin Hajibandeh, Rajnish Mankotia & Rajeev Peravali

  3. Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK

    Shahab Hajibandeh

  4. Department of General and Colorectal Surgery, Russells Hall Hospital, Dudley, UK

    Akinfemi Akingboye

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  1. Shahin Hajibandeh
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  2. Shahab Hajibandeh
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  4. Akinfemi Akingboye
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  5. Rajeev Peravali
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Contributions

Conception and design: SH, RP. Literature search and study selection: SH, SH. Data collection: SH, SH. Analysis and interpretation: SH, SH. Writing the article: SH, SH. Critical revision of the article: All authors.

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Correspondence to Shahin Hajibandeh.

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Hajibandeh, S., Hajibandeh, S., Mankotia, R. et al. Meta-analysis of randomised controlled trials comparing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: upgrading the level of evidence. Updates Surg 73, 23–33 (2021). https://doi.org/10.1007/s13304-020-00948-7

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