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A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy

  • Systematic Reviews and Meta-analyses
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Abstract

Purpose

Two main techniques are commonly used during laparoscopic right hemicolectomy in order to perform the ileocolic anastomosis: intracorporeal (IA) and extracorporeal (EA). The aim of this study was to evaluate the safety of the two techniques.

Methods

A systematic review was carried out to identify studies comparing IA and EA. The primary endpoint was anastomotic leakage. The secondary endpoints were intra- and postoperative results. A meta-analysis was carried out using the random-effects model.

Results

Fourteen studies matched the selection criteria, enrolling 1717 patients (50.3 % IA, 49.7 % EA). The anastomotic leakage was similar in the IA and the EA groups (3.4 vs. 4.6 %, respectively) with a risk difference (RD) of −0.01 (95 % CI = −0.03 to 0.01; P = 0.120). IA group had lower overall complication rate (27.6 vs. 38.4 %; RD = −0.15; 95 % CI = 0.27 to −0.04; P = 0.009) and wound infection rate (4.9 vs. 8.9 %; RD = 0.52; −0.03; 95 % CI = −0.06 to −0.01; P = 0.030). Time to first oral intake (weighted mean difference (WMD) = −1; 95 % CI = −1.59 to −0.41; P < 0.001), length of hospital stay (WMD = −1.13; 95 % CI = −1.90 to −0.35; P = 0.004) and minilaparotomy size (WMD = −26; 95 % CI = −38 to −13; P < 0.001) were shorter in IA patients. The incisional hernia rate was lower in the IA group (2.3 vs. 13.7 %) with an RD of −0.09 (95 % CI = −0.17 to −0.02; P = 0.020). There were no differences in operative time, blood loss, conversion, internal hernia, reoperation, mortality, time to first flatus and defecation, analgesic required, number of lymph nodes harvested and length of distal margin.

Conclusions

Laparoscopic right hemicolectomy with IA is a safe alternative to EA. Additional well-structured, prospective randomised trials are needed to confirm all the advantages regarding postoperative results which were pointed out in our study.

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Authors and Affiliations

  1. Department of Internal Medicine and Surgery, (DIMEC) Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

    Claudio Ricci, Riccardo Casadei, Vincenzo Alagna, Elia Zani, Giovanni Taffurelli, Carlo Alberto Pacilio & Francesco Minni

  2. Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy

    Claudio Ricci

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  2. Riccardo Casadei
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Correspondence to Claudio Ricci.

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Funding

Claudio Ricci declares that he did not receive any funding for this manuscript.

Riccardo Casadei declares that he did not receive any funding for this manuscript.

Vincenzo Alagna declares that he did not receive any funding for this manuscript.

Elia Zani declares that he did not receive any funding for this manuscript.

Giovanni Taffurelli declares that he did not receive any funding for this manuscript.

Carlo Alberto Pacilio declares that he did not receive any funding for this manuscript.

Francesco Minni declares that he did not receive any funding for this manuscript.

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The authors declare that they no conflict of interest.

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This article does not contain any studies with human participants carried out by any of the authors.

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Ricci, C., Casadei, R., Alagna, V. et al. A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy. Langenbecks Arch Surg 402, 417–427 (2017). https://doi.org/10.1007/s00423-016-1509-x

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