Intracorporeal Anastomosis Reduces Surgical Stress Response in Laparoscopic Right Hemicolectomy: A Prospective Randomized Trial

Abstract

Total laparoscopic right hemicolectomy is a procedure that involves an intracorporeal anastomosis. This approach may reduce tissue injury resulting in a significant lower surgical stress response (SSR) compared with the same procedure performed with an extracorporeal anastomosis. The purpose of this study was to compare the SSR level between 2 groups of patients undergoing laparoscopic right hemicolectomy with intracorporeal or extracorporeal anastomosis. From June 2015 to December 2016, 60 patients were enrolled and randomized. Interleukin-6, C-reactive protein, procalcitonin, white blood cell count, cortisol, prolactin, prealbumin, albumin, triglycerides, and transferrin were analyzed preoperatively and at 1, 3, and 5 days postoperatively. Interleukin-6 and C-reactive protein levels were significantly lower in the intracorporeal group on days 1, 3, and 5 postoperatively compared with the extracorporeal group. Gastrointestinal recovery was significantly earlier in the intracorporeal group. The intracorporeal anastomosis in laparoscopic right hemicolectomy reduces SSR, which may play a role in bowel recovery.

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“…The authors did not find a difference in favor of one of the 2 techniques. These results were consistent with 4 randomized trials published later (level 1B) [36][37][38][39].…”

“…1) [3, published between 2002 and 2020. These articles were distributed as follows: 44 reviews [3, 9-19, 21-28, 30-35, 40-44, 46-56] including 33 metaanalysis (Table 1) [10, 11, 16-19, 21, 23-28, 30, 31, 33-35, 40, 42-44, 46-52, 54-56] and 7 RCTs (Table 2) [20,29,[36][37][38][39]45]. Table 3 summarizes included studies' findings and evidence levels.…”

Short- and long-term outcomes of totally robotic versus robotic-assisted radical distal gastrectomy for advanced gastric cancer: a mono-institution retrospective study

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