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Intracorporeal versus extracorporeal anastomosis in minimally invasive right colectomy: an updated systematic review and meta-analysis

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Abstract

Background

Minimally invasive colectomy has become the standard for treatment of colonic disease in many centers. Restoration of bowel continuity following resection can be achieved by intracorporeal (IC) or extracorporeal (EC) anastomosis. The aim of this systematic review was to assess the outcomes of IC compared to EC anastomosis in minimally invasive right colectomy.

Methods

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic literature search for studies assessing the outcome of IC and EC anastomosis in laparoscopic and robot-assisted right colectomy was conducted. The primary outcome of this review was postoperative complications. Secondary outcomes included operative time, blood loss, length of stay, conversion to open surgery, and bowel recovery.

Results

Twenty-five studies including 4450 patients were evaluated. 47.7% of patients had IC anastomosis and 52.3% had EC anastomosis. The weighted mean length of extraction site incision in the IC group was shorter than the EC group. The EC group had significantly higher odds of conversion to open surgery (OR 1.87, 95% CI 1–3.45, p = 0.046), total complications (OR 1.54, 95% CI 1.05–2.11, p = 0.007), anastomotic leakage (AL) (OR 1.95, 95% CI 1.4–2.7, p = 0.003), surgical site infection (SSI) (OR 1.69, 95% CI 1.4–2.6, p = 0.002), and incisional hernia (OR 3.14, 95% CI 1.85–5.33, p < 0.001) compared to the IC group. Both groups had similar rates of ileus, small bowel obstruction, bleeding, and intra-abdominal infection.

Conclusion

IC anastomosis was associated with significantly shorter extraction site incisions, earlier bowel recovery, fewer complications, and lower rates of conversion, AL, SSI, and incisional hernia than has the EC anastomosis.

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Authors and Affiliations

  1. Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 Elgomhuoria Street, PO: 35516, Mansoura, Egypt

    S. H. Emile, H. Elfeki, M. Shalaby, A. Sakr & M. Bassuni

  2. Department of Surgery, Aarhus University Hospital, Aarhus, Denmark

    H. Elfeki & P. Christensen

  3. Colorectal Surgery Department, Yonsei University College of Medicine, Seoul, South Korea

    A. Sakr

  4. Department of Surgery, King’s College London, London, UK

    M. Bassuni

  5. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    S. D. Wexner

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Contributions

SHE designed the study. SHE, HE, MS, and AS participated in data collection and analysis, writing and drafting of the manuscript. MB and PC participated in data interpretation, drafting, and critical revision of the manuscript. SDW reviewed the collected results on regular basis and participated in drafting and critical revision of the manuscript.

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Correspondence to S. H. Emile.

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Emile, S.H., Elfeki, H., Shalaby, M. et al. Intracorporeal versus extracorporeal anastomosis in minimally invasive right colectomy: an updated systematic review and meta-analysis. Tech Coloproctol 23, 1023–1035 (2019). https://doi.org/10.1007/s10151-019-02079-7

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