Abstract
Background
This study was performed to evaluate short-term clinical outcomes of laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon.
Methods
This was a retrospective study of selected patients who underwent laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon for tumors or Crohn’s disease by a single surgeon from July 2002 through June 2012. Data were retrieved from an Institutional Review Board-approved database. Study end point was postoperative adverse events, including mortality, complications, reoperations, and readmissions at 30 days. Antiperistaltic side-to-side anastomoses were fashioned laparoscopically with a 60-mm-long stapler cartridge and enterocolotomy was hand-sewn intracorporeally in two layers. Values were expressed as medians (ranges) for continuous variables.
Results
There were 243 patients (143 females) aged 61 (range = 19–96) years, with body mass index of 29 (18–43) kg/m2 and ASA 1:2:3:4 of 52:110:77:4; 30 % had previous abdominal surgery and 38 % had a preexisting comorbidity. There were 84 ileocolic resections with ileo ascending anastomosis and 159 right colectomies with ileotransverse anastomosis. Operating time was 135 (60–220) min. Estimated blood loss was 50 (10–600) ml. Specimen extraction site incision length was 4.1 (3–4.4) cm. Conversion rate was 3 % and there was no mortality at 30 days, 15 complications (6.2 %), and 8 reoperations (3.3 %). Readmission rate was 8.7 %. Length of stay was 4 (2–32) days. Pathology confirmed Crohn’s disease in 84 patients, adenocarcinoma in 152, and other tumors in 7 patients.
Conclusion
Laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon resulted in a favorable outcome in selected patients with Crohn’s disease or tumors of the right colon.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schlinkert RT (1991) Laparoscopic-assisted right hemicolectomy. Dis Colon Rectum 34:1030–1031
Young-Fadok TM, Nelson H (2000) Laparoscopic right colectomy: five-step procedure. Dis Colon Rectum 43:267–271 discussion 271–273
Senagore A, Delaney C, Brady K, Fazio V (2004) Standardized approach to laparoscopic right colectomy: outcomes in 70 consecutive cases. J Am Coll Surg 5:675–679
Ou H (1995) Laparoscopic-assisted mini laparotomy with colectomy. Dis Colon Rectum 38:324–326
Casciola L, Ceccarelli G, Di Zitti L (2003) Laparoscopic right hemicolectomy with intracorporeal anastomosis. Technical aspects and personal experience. Minerva Chir 58:621–627
Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie A, Fitzgerald A (2011) Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev 7(9):004320
Blumberg D (2009) Laparoscopic colectomy performed using a completely intracorporeal technique is associated with similar outcomes in obese and thin patients. Surg Laparosc Endosc Percutan Tech 19:57–61
Hellan M, Anderson C, Pigazzi A (2009) Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS 13:312–317
Grams J, Tong W, Greenstein AJ, Salky B (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891
Scatizzi M, Kroning K, Borrelli A, Andan G, Lenzi E, Ferroci F (2010) Extracorporeal versus intracorporeal anastomosis after laparoscopic right colectomy for cancer: a case-control study. World J Surg 34:2902–2908
Chaves JA, Idoate CP, Fons JB, Oliver NB, Rodriguez NP, Delgado AB, Lizoain JLH (2011) A case control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic hemicolectomy. Cir Esp 89:24–30
Fabozzi M, Allieta R, Contul RB, Grivin 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 24:2085–2091
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 240:205–213
Cabot JC, Lee SA, Yoo J, Nasar A, Whelan RL, Feingold DL (2010) Long-term consequences of not closing the mesenteric defect after laparoscopic right colectomy. Dis Colon Rectum 53:289–292
Causey MW, Oguntoye M, Steele SR (2011) Incidence of complications following colectomy with mesenteric closure versus no mesenteric closure: does it really matter? J Surg Res 171:571–575
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 22:2596–2600
Acknowledgments
The authors thank Eman Kazi for assistance with the manuscript.
Disclosures
Drs. Chang, Barnajian, Tarta, and Bergamaschi, and Mr. Fakoury have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chang, K., Fakhoury, M., Barnajian, M. et al. Laparoscopic right colon resection with intracorporeal anastomosis. Surg Endosc 27, 1730–1736 (2013). https://doi.org/10.1007/s00464-012-2665-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2665-x