Totally Laparoscopic Right Colectomy: Theoretical and Practical Advantages over the Laparo-assisted Approach

Marchesi, Federico; Pinna, Ferdinando; Percalli, Luigi; Cecchini, S.; Riccò, Matteo; Costi, Roberta; Pattonieri, Vittoria; Roncoroni, L

doi:10.1089/lap.2012.0420

Cited by 40 publications

(34 citation statements)

References 12 publications

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“…Eleven studies were of retrospective design [13, 15–19, 32–36]. Milone et al [16] matched the control group using a propensity score.…”

Section: Resultsmentioning

confidence: 99%

“…Study design and patient characteristics are described in Table 1. In nine studies, the intracorporeal performed anastomosis was created using a mechanical stapler with [13–15, 17–19, 33, 35, 36] or without [16] additional sutures in the IA technique. A mechanical stapler was most commonly used for the extracorporeal anastomosis as well (with [13, 14, 18, 36] or without [16, 19] additional sutures).…”

Section: Resultsmentioning

confidence: 99%

“…A mechanical stapler was most commonly used for the extracorporeal anastomosis as well (with [13, 14, 18, 36] or without [16, 19] additional sutures). One study made a hand-sewn anastomosis [15] or according to the preference of the individual surgeon (mechanical or hand-sewn) [17, 33]. Two studies did not specify the creation of the anastomosis [32, 34].…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, Scatizzi et al [36] defined short-term outcomes as 90 days and reported an outpatient clinic visit 8 days after discharge, but subsequently failed to report on the 3 month FU besides readmission. Half of the studies changed their way of operation halfway during the score inclusion period from EA to IA, using their last EA as ‘historic’ control group [15, 18, 19, 32, 33, 35]. All studies scored low on unbiased assessment of outcomes due to lack of blinding and randomization.…”

Section: Resultsmentioning

confidence: 99%

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Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis

et al. 2016

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BackgroundLaparoscopic right hemicolectomy for colon cancer is associated with substantial morbidity despite the introduction of enhanced recovery protocols and laparoscopic surgery. Laparoscopic right hemicolectomy with an intracorporeal anastomosis (IA) is less invasive than laparoscopic assisted hemicolectomy, possibly leading to further decrease in post-operative morbidity and faster recovery. The current standard technique includes an extracorporeal anastomosis with mobilization of the colon, mesenteric traction and a extraction wound located in the mid/upper abdomen with relative more post-operative morbidity compared to extraction wounds located in the lower abdomen.MethodsA systematic review of PubMed and Embase databases was performed on studies comparing the intracorporeal versus the extracorporeal performed anastomosis in laparoscopic right hemicolectomy. Primary outcomes were mortality, short-term morbidity and length of stay. For quality assessment, the MINORS checklist was used. Meta-analysis was performed using a random-effects model, and a subgroup analysis was performed for data regarding short-term morbidity and length of stay in studies published in 2012≥.ResultsA total of 2692 papers were identified, 12 non-randomized comparative studies were included in the analysis with a total number of 1492 patients. No significant change in mortality was found (OR 0.36, 95 % CI 0.09–1.46; I 2 = 0 %). Short-term morbidity decreased significantly in favour of IA (OR 0.68, 95 % CI 0.49–0.93; I 2 = 20 %). Length of stay was decreased, but with serious risk of heterogeneity (MD −0.77 days, 95 % CI −1.46 to −0.07; I 2 = 81 %). Subgroup analysis for papers published in 2012≥ resulted in an even larger decrease in short-term morbidity (OR 0.65, 95 % CI 0.50–0.85; I 2 = 0 %) and a significant decrease in length of stay with low risk of heterogeneity (MD −0.77 days, 95 % CI −1.17 to −0.37; I 2 = 4 %).ConclusionIntracorporeal anastomosis in laparoscopic right hemicolectomy is associated with reduced short-term morbidity and decreased length of hospital stay suggesting faster recovery as shown in this meta-analysis.

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“…Eleven studies were of retrospective design [13, 15–19, 32–36]. Milone et al [16] matched the control group using a propensity score.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis

et al. 2016

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“…TL approach seems to present some advantages [2,3]: 1. Functional : The smaller size of Parapubic minilaparotomy, with a low risk of infection and incisional hernias, reduced postoperative pain, determined an inferior risk of respiratory infection and a better postoperative course and subsequently a shorter hospitalization and reduced assistance costs.…”

Section: Discussionmentioning

confidence: 99%

Open vs totally laparoscopic right colectomy: technique and results

Fabozzi¹,

Allieta²,

Grimaldi

et al. 2013

BMC Surg

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Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial)

Bollo

Turrado

Fueyo

et al. 2019

British Journal of Surgery

120

132

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Background Several non‐randomized and retrospective studies have suggested that intracorporeal anastomosis (IA) has advantages over extracorporeal anastomosis (EA) in laparoscopic right colectomy, but scientific evidence is lacking. The aim was to compare short‐term outcomes and to define the possible benefits of IA compared with EA in elective laparoscopic right colectomy. Methods An RCT was conducted from May 2015 to June 2018. The primary endpoint was duration of hospital stay. Secondary endpoints were intraoperative technical events and postoperative clinical outcomes. Results A total of 140 patients were randomized. Duration of surgery was longer for procedures with an IA than in those with an EA (median 149 (range 95–215) versus 123 (60–240) min; P < 0·001). Wound length was shorter in the IA group (median 6·7 (4–9·5) versus 8·7 (5–13) cm; P < 0·001). Digestive function recovered earlier in patients with an IA (median 2·3 versus 3·3 days; P = 0·003) and the incidence of paralytic ileus was lower (13 versus 30 per cent; P = 0·022). Less postoperative analgesia was needed in the IA group (mean(s.d.) weighted analgesia requirement 39(24) versus 53(26); P = 0·001) and the pain score was also lower (P = 0·035). The postoperative decrease in haemoglobin level was smaller (mean(s.d.) 8·8(1·7) versus 17·1(1·7) mg/dl; P = 0·001) and there was less lower gastrointestinal bleeding (3 versus 14 per cent; P = 0·031) in the IA group. IA was associated with a significantly better rate of grade I and II complications (P = 0·016 and P = 0·037 respectively). The duration of hospital stay was slightly shorter in the IA group (median 5·7 (range 2–19) versus 6·6 (2–23) days; P = 0·194). Conclusion Duration of hospital stay was similar, but IA was associated with less pain and fewer complications. Registration number: NCT02667860 ( http://www.clinicaltrials.gov).

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Totally Laparoscopic Right Colectomy: Theoretical and Practical Advantages over the Laparo-assisted Approach

Cited by 40 publications

References 12 publications

Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis

Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis

Open vs totally laparoscopic right colectomy: technique and results

Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial)

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