Ann Surg Treat Res.  2024 Jul;107(1):42-49. 10.4174/astr.2024.107.1.42.

Comparing extracorporeal, semi-extracorporeal, and intracorporeal anastomosis in laparoscopic right hemicolectomy: introducing a bridging technique for colorectal surgeons

• Cho HJ
• Kim JW
• Kim WR

• KMID: 2557579
• DOI: http://doi.org/10.4174/astr.2024.107.1.42

Abstract

Purpose
Intracorporeal anastomosis (IA) in laparoscopic right hemicolectomy has been associated with faster recovery in bowel function compared to extracorporeal anastomosis (EA). However, the technical difficulty of laparoscopic suturing technique and intraabdominal fecal contamination hinder many surgeons from implementing such a procedure. We introduce and compare a bridging technique designated as “semi-extracorporeal” anastomosis (SEA), which embraces the advantages and amends the drawbacks of IA and EA.
Methods
Between May 2016 and October 2022, 100 patients who underwent laparoscopic right hemicolectomy were analyzed. All patients who received laparoscopic right hemicolectomy underwent one of the 3 anastomosis methods (EA, SEA, and IA) by a single colorectal surgeon at a single tertiary care hospital. Data including perioperative parameters and postoperative outcomes were analyzed by each group.
Results
A total of 100 patients were reviewed. Thirty patients underwent EA; 50 and 20 patients underwent SEA and IA, respectively. Operation time (minute) was 170 (range, 100–285), 170 (range, 110–280), and 147.5 (range, 80–235) in EA, SEA, and IA, respectively (P = 0.010). Wound size was smaller in SEA and IA compared to EA (P < 0.001). IA was associated with a shorter time (day) to first flatus compared to SEA and EA (4 [range, 2–13] vs. 4 [range, 2–7] vs. 2.5 [range, 1–4], P < 0.001). Postoperative complication showed no statistical significance between the 3 groups.
Conclusion
Semi-extracorporeal was an attractive bridging option for colorectal surgeons worrisome of the technical difficulty of IA while maintaining faster bowel recovery and smaller wound incisions compared to EA.

Keyword

Surgical anastomosis; Laparoscopy; Hemicolectomy

Figure

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  Fig. 1 Flowchart of selection of patients.

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  Fig. 2 Semi-extracorporeal anastomosis surgical technique. (A) Transverse colon resection with Endo GIA (Medtronic). (B) Terminal ileum resection with Endo GIA. (C) Intracorporeal tagging suture of the transected bowels. (D) Extracorporeal anastomosis performed in semi-extracorporeal anastomosis.

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