Intracorporeal Anastomoses in Minimally Invasive Right Colectomies Are Associated With Fewer Incisional Hernias and Shorter Length of Stay

Widmar, Maria; Aggarwal, Piyush; Keskin, Metin; Strombom, Paul; Patil, Sujata; Smith, J. Joshua; Nash, Garrett M.; García-Aguilar, Julio

doi:10.1097/dcr.0000000000001612

Cited by 48 publications

(46 citation statements)

References 36 publications

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“…The shorter LOS represents an overall better recovery after surgery with the IA method, which includes less wound pain, less stress on the bowel, and better recovery of bowel function. Many systemic reviews and meta-analyses have demonstrated similar findings [ 22 – 27 ]. The IA method has the following advantages: lower analgesic use, faster time to bowel movement and flatus passage, shorter time to solid food intake, and shorter length of hospitalization.…”

Section: Discussionmentioning

confidence: 60%

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Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study

et al. 2021

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Backgrounds Though better short-term outcomes were frequently reported, differences in specimen parameters and the rate of subsequent peritoneal recurrence between intracorporeal anastomosis (IA) and extracorporeal anastomoses (EA) for laparoscopic right hemicolectomy have not been analyzed. We aimed to compare the pathologic differences and oncological outcomes between these two approaches. Methods We retrospectively analyzed 217 consecutive patients who underwent laparoscopic right hemicolectomies from September 2016 to April 2018 and classified them into IA and EA groups, based on the approach used. Propensity score matching analysis was performed, after which 101 patients were included in each group with the patients matched for demographics, tumor stage, and localization. Results The IA group had a longer operative time, shorter length of stay, shorter time to first flatus and tolerating a soft diet, and better pain scale scores at postoperative day 3. No inter-group differences in conversion, postoperative complication, mortality, or readmission rates were found. The IA group had a longer resected colon length (23.67 vs. 19.75 cm, p = 0.010) and nearest resected margin (7.51 vs. 5.40 cm, p = 0.010) for cancer near the hepatic flexure. There are comparable 3-year overall survival (87.7% vs. 89.6%, p = 0.604) and disease-free survival (75.0% vs. 75.7%, p = 0.842) between the IA and EA groups. The rate of peritoneal recurrence was similar between the two groups (5.9% vs. 7.9%, p = 0.580). Conclusions The overall survival, disease-free survival, and the rate of peritoneal recurrence were comparable between the IA and EA procedures. IA ensures better recovery and comparable complications to EA and achieved a more precise tumor excision; thus, IA can be considered a safe procedure for patients with right-sided colon lesions.

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Section: Discussionmentioning

confidence: 60%

“…The IA method has the following advantages: lower analgesic use, faster time to bowel movement and flatus passage, shorter time to solid food intake, and shorter length of hospitalization. The postoperative complications were comparable between the two methods [ 7 , 8 , 10 , 24 – 27 ].…”

Section: Discussionmentioning

confidence: 97%

Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study

et al. 2021

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“…The shorter LOS represents an overall better recovery after surgery with the IA method, which includes less wound pain, less stress on the bowel, and better recovery of bowel function. Many systemic reviews and meta-analyses have demonstrated similar ndings [22][23][24][25]. The IA method has the following advantages: lower analgesic use, faster time to bowel movement and atus passage, shorter time to solid food intake, and shorter length of hospitalization.…”

Section: Discussionmentioning

confidence: 79%

“…The IA method has the following advantages: lower analgesic use, faster time to bowel movement and atus passage, shorter time to solid food intake, and shorter length of hospitalization. The postoperative complications were comparable between the two methods [7,8,[22][23][24][25][26].…”

Section: Long-term Postoperative Outcomesmentioning

confidence: 78%

Is Increased Peritoneal Seeding a Drawback After Using Intracorporeal Anastomosis in Laparoscopic Right Colectomy? A Propensity Score-Matched Study

Liao

Chern

Lin

et al. 2020

Preprint

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Backgrounds: Though better short-term outcomes were frequently reported, differences in specimen parameters and the rate of subsequent peritoneal seeding between intracorporeal anastomosis (IA) and extracorporeal anastomoses (EA) for laparoscopic right hemicolectomy have not been analyzed. We aimed to compare the pathologic differences and oncological outcomes between these two approaches.Methods: We retrospectively analyzed 217 consecutive patients who underwent laparoscopic right hemicolectomies from September 2016 to April 2018, and classified them into IA and EA groups, based on the approach used. Propensity score matching analysis was performed, after which 101 patients were included in each group.Results: The IA group had a longer operative time, shorter length of stay, shorter time to first flatus and tolerating a soft diet, and better pain scale scores at postoperative day 3. No inter-group differences in conversion, postoperative complication, mortality, or readmission rates were found. The IA group had a longer resected colon length (23.67 vs. 19.75 cm, p=0.010) and nearest resected margin (7.51 vs. 5.40 cm, p=0.010) for cancer near the hepatic flexure. There are comparable 3-year overall survival (87.7% vs. 89.6%, p=0.604) and disease free survival (75.0% vs. 75.7%, p=0.842) between IA and EA groups. The occurrence of peritoneal seeding was similar between the groups too.Conclusions: IA ensures better recovery and comparable complications to EA. The former also achieved a more precise tumor excision. It is a valid technique without compromising oncological outcomes.

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“…Robotic surgery eases suturing and enables reinforcement of the stapled anastomosis, facilitating intracorporeal anastomoses [2]. The latter have been associated with reduced incidence of hernia and faster recovery [3]. Drawbacks of the robotic approach are the associated costs and longer operative time [4].…”

mentioning

confidence: 99%

Robotic right hemicolectomy and partial nephrectomy for synchronous malignancies – a video vignette

2020

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Multiple abdominal and perineal approaches have been described for the treatment of full-thickness rectal prolapse. There has been no consensus on the optimal approach, with randomized controlled trials and metaanalysis failing to show superiority of any particular approach [1,2]. Recently, use of the laparoscopic abdominal approach has increased, although this technique may not be suitable for all patients [3]. The Delorme's procedure is useful for treating rectal prolapse in elderly patients with significant comorbidities, patients at high risk for general anaesthesia and patients with recurrence after an abdominal procedure [4,5]. We describe the steps of the procedure in a 65-yearold man with a recurrent rectal prolapse (Video S1). The procedure can be performed under general or spinal anaesthesia, with the patient in the lithotomy position. Use of a headlight is advisable. The prolapse is reproduced to assess the length of mucosectomy required (double the length of the prolapse). After application of a Lone Star retractor (Cooper Surgical, Trumbull, CT, USA), the dentate line is visualized and the mucosa marked circumferentially 2 cm proximally. The submucosa is infiltrated with a saline/ adrenaline solution (1:100 000) and incised circumferentially. A mucosal sleeve is developed, with care being taken not to buttonhole the mucosa or the muscle. This is followed by plication of the muscle with 2-0 or 3-0 Polydioxanone and mucosal approximation with 3-0 polygalactin. Our patient made an uneventful recovery and was recurrence-free 10 months after the procedure. The Delorme's procedure can be a valuable tool for treating a select group of patients with rectal prolapse. A stepwise approach helps to standardize the procedure and reduces intra-operative complications and postoperative morbidity.

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Intracorporeal Anastomoses in Minimally Invasive Right Colectomies Are Associated With Fewer Incisional Hernias and Shorter Length of Stay

Cited by 48 publications

References 36 publications

Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study

Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study

Is Increased Peritoneal Seeding a Drawback After Using Intracorporeal Anastomosis in Laparoscopic Right Colectomy? A Propensity Score-Matched Study

Robotic right hemicolectomy and partial nephrectomy for synchronous malignancies – a video vignette

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