A case-control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic hemicolectomy

Arredondo Chaves, Jorge; Pastor Idoate, Carlos; Baixauli Fons, Jorge; Bellver Oliver, Manuel; Pedano Rodríguez, Nicolás; Bueno Delgado, Álvaro; Hernández Lizoain, José Luis

doi:10.1016/S2173-5077(11)70005-9

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Abstract

Introduction

There is still insufficient scientific evidence on which is the best technique to perform the anastomosis -intracorporeal (IC) or extracorporeal (EC)- in right laparoscopic hemicolectomy. The objective of the present study is to determine whether there are differences to compare in both techniques.

Material and methods

A study was performed on a prospective patient series subjected to right laparoscopic hemicolectomy in our Hospital. The preoperative and the postoperative variables associated with complications recorded depending on the type of anastomosis.

Results

A total of 60 patients were intervened form June 2004 to June 2010 (35 IC; 25 EC). There were no significant differences between both groups as regards baseline preoperative characteristics or associated comorbidities. The median operation time was 212 minutes (142–305min), with no significant difference between both techniques. The number of lymph nodes removed was higher in the IC group (21 vs 14; P=.03). The beginning of oral tolerance and the first bowel movement were significantly earlier in the IC group. The complications rate was similar for both groups (14% IC; 16% EC; P=.89). Three patients in the IC group had anastomosis dehiscence. The mortality rate was 2.8% (one patient in each group)

Conclusion

Intracorporeal versus extracorporeal anastomosis in right laparoscopic hemicolectomy can obtain a higher number of resected lymph nodes and an earlier oral tolerance and intestinal transit.

Keywords:

Colorectal surgery

Right laparoscopic

hemicolectomy

Intracorporeal anastomosis

Resumen

Introducción

En la actualidad no existe suficiente evidencia científica sobre cuál es la mejor técnica para realizar la anastomosis −intracorpórea (IC) o extracorpórea (EC)− en la hemicolectomía derecha laparoscópica. El objetivo del presente estudio es determinar si existen diferencias al comparar ambas técnicas.

Material y métodos

Se realiza un estudio sobre una serie prospectiva de pacientes intervenidos en nuestro Centro mediante hemicolectomía derecha laparoscópica. Se comparan las variables preoperatorias, intraoperatorias y relacionadas con complicaciones recogidas en función del tipo de anastomosis.

Resultados

Desde junio de 2004 hasta junio de 2010 se intervinieron 60 pacientes (35 IC; 25 EC). No existieron diferencias significativas entre ambos grupos en cuanto a características basales preoperatorias ni comorbilidades asociadas. La mediana de tiempo operatorio fue de 212 minutos (142-305 min), sin diferencias significativas entre ambas técnicas. El número de ganglios extraídos resultó mayor en el grupo IC (21 versus 14; p=0,03). Tanto el inicio de la tolerancia oral como la primera deposición resultaron significativamente más precoces en el grupo IC. La tasa de complicaciones postoperatorias fue similar para ambos grupos (14% IC; 16% EC; p=0,89). Tres pacientes presentaron dehiscencia de anastomosis en las IC. La tasa de mortalidad fue del 2,8% (un paciente en cada grupo).

Conclusión

La anastomosis intracorpórea frente a la extracorpórea en la hemicolectomía derecha laparoscópica permite obtener un mayor número de ganglios resecados y un inicio más precoz de la tolerancia oral y del tránsito intestinal.

Palabras clave:

Cirugía colorrectal

Hemicolectomía derecha

laparoscópica

Anastomosis intracorpórea

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☆

Speech presented at XVIII Jornadas Internacionales. “Masterclass” en Coloproctología (18th International Conference. Masterclass in Coloproctology). Colorectal Laparoscopic Surgery. 24–26 February, 2010, in Baiona, Spain.

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