Bowel Anastomosis in Single Port Laparoscopic Right Hemicolectomy: Comparison of Functional End to End Anastomosis and Isoperistaltic Side to Side Anastomosis

Yun, Seong Hyeon; Chung, Seung Woo; Yun, Jung A; Park, Yoon Ah; Huh, Jung Wook; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong

Abstract

PURPOSE
Colorectal surgeries by single port laparoscopic surgery (SPLS) are increasing. While recent studies have reported results that are similar with the idea of conventional laparoscopy, SPLS is considered superior to conventional laparoscopy with regard to cosmetic aspects. We investigated the question of whether length of incision and postoperative recovery are different depending on the method of anastomosis in patients who underw ent SPLS right hemicolectomy (RHC).
METHODS
Data on patients who underwent SPLS RHC from May 2011 to April 2012 at Samsung Medical Center were retrospectively collected. Among 117 patients, 31 received functional end-to-end anastomosis (FEEA) while 86 received isoperistaltic side-to-side anastomosis (ISSA).
RESULTS
Operation time was shorter in FEEA compared to ISSA (152+/-42 vs 172+/-35 min, p=0.01). Neither group required an additional port. Although wound extension for specimen delivery tended to be frequent in loop type specimen after FEEA, the result was statistically insignificant (58.1 vs 43.0%, p=0.15). No difference in wound length was observed (4.4+/-1.0 vs 4.5+/-1.5 cm). Length of stay was longer in ISSA compared to FEEA (6.3+/-2.1 vs 7.9+/-4.3 days, p=0.01), and there was no difference in first gas passage (2.5+/-0.9 vs 2.8+/-0.9 days, p=0.26). Although three patients (9.7%) with FEEA and 19 patients (22.1%) with ISSA had postoperative complications, the difference was insignificant.
CONCLUSION
Theoretically, delivery of a tube shaped specimen after ISSA is expected to reduce unnecessary wound extension and possible tumor dissemination compared to loop shape specimen after FEEA. However, results of our study showed no advantage in recovery period and wound length. We suggest that future prospective study might reveal more valuable conclusions on the subject.