Technical aspects of performing intracorporeal anastomosis in laparoscopic right hemicolectomy

Abstract

We present various methods of performing intracorporeal anastomosis in laparoscopic right hemicolectomy. The literature currently reports multiple benefits of intracorporeal anastomosis compared to extracorporeal anastomosis, for example earlier recovery of bowel function, less postoperative pain, utility in obese patients with shortened mesentery, clear visualization of bowel orientation, and equivalent anastomotic leak and 30-day morbidity rates. [1-4] Several methods of performing intracorporeal anastomosis have been reported with no one technique demonstrating superiority over others. The aim of this video is to demonstrate multiple techniques of performing intracorporeal anastomosis in right hemicolectomy, namely anti-peristaltic anastomosis with V-loc closure of common channel; iso-peristaltic anastomosis with interrupted PDS closure of common channel; and functional end-to-end anti-peristaltic anastomosis with double staple technique (Video 1).We summarize the pros and cons of each method at the end of the video. For example, the double-stapled method can be performed quickly and easily but involves cutting across staple lines with the potential risk of stapler malformation, as well as the downside of higher cost of surgery. Interrupted closure of the common channel lacks these issues; however, it is time-consuming and necessary for the surgeon to be proficient with intracorporeal suturing. V-loc closure of the common channel is a compromise between these methods, but use of a barbed suture on bowel is associated with a potential albeit low risk of anastomotic leak or stenosis.In conclusion, there are many possible ways to perform intracorporeal anastomosis in right hemicolectomy, each with advantages and disadvantages. Choice of technique will probably depend on surgeon preference.