PERIOPERATIVE RESULTS OF INTRACORPOREAL VERSUS EXTRACORPOREAL ANASTOMOSIS IN LAPAROSCOPIC RIGHT COLECTOMY
Leonardo Cárcamo1,3, Eugenio Grasset*1,2, Gonzalo Urrejola1, Rodrigo Migueles1, Maria Molina1, Felipe Bellolio1, Jose T. Larach1
1Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile; 2Surgery, Universidad de Chile, Santiago, Chile; 3Surgery, Universidad Austral de Chile, Valdivia, Chile
Introduction
Reconstruction in laparoscopic right colectomy (LRC) can be undertaken either by performing an intracorporeal (ICA) or extracorporeal anastomosis (ECA). The aim of this study is to compare perioperative outcomes of patients undergoing ICA versus ECA.
Methods
Patients undergoing elective LRC with ICA or ECA in a single institution were included from January 2015 to May 2018 into a non-concurrent cohort study. All ICA where performed by two of five attending surgeons in our unit. Demographic, clinical, pathological and perioperative variables were compared. In addition, a logistic regression was performed to identify factors associated with postoperative morbidity in LRC.
Results
From 99 patients identified of whom 36 had an ICA, the main indication for surgery was colon cancer in both groups (83% for ICA versus 81% for ECA; p=0,127) with no differences in tumor location, size, TNM stage or lymph nodes resected in this subgroups. Operative time was significantly longer for ICA (median of 180 [IQR: 150-210] versus 150 [120-180] minutes; p=0.001). Regarding the extraction site, a suprapubic transverse minilaparotomy incision was used in 97.2% of patients with ICA and a midline incision was used in 96.8% of ECA (p < 0.001). Hospital stay, number of total complications and morbidity according to Clavien-Dindo were similar between both groups. There were 8.3% and 4.7% anastomotic leaks in ICA and ECA, respectively (p=0.665) of whom all where successfully treated with antibiotics alone (Clavien-Dindo II). From the multivariate analysis, the Charlson comorbidity index and extended right colectomy were independently associated with postoperative morbidity.
Conclusion
LRC with ICA is a safe procedure. In this initial experience, postoperative results are similar to LRC with ECA at the expense of longer operative time.
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