Ann Surg Treat Res.  2023 Mar;104(3):156-163. 10.4174/astr.2023.104.3.156.

Effect of intracorporeal anastomosis on postoperative ileus after laparoscopic right colectomy

• Kim S
• Bae SU
• Jeong WK
• Baek SK
• Son YG

• KMID: 2539694
• DOI: http://doi.org/10.4174/astr.2023.104.3.156

Abstract

Purpose
Laparoscopic right colectomy (LRC) with extracorporeal anastomosis (ECA) remains the most widely adopted technique despite mounting evidence that intracorporeal anastomosis (ICA) offers several advantages. This study aimed to compare the postoperative outcomes of ICA and ECA and to investigate the effect of ICA on postoperative ileus after LRC.
Methods
This retrospective study included 45 patients who underwent ICA and 63 who underwent ECA in LRC for rightsided colonic diseases between January 2015 and December 2019.
Results
There were no significant differences in total operation time, blood loss, total length of incisions, tolerance of diet, postoperative pain score on postoperative days 1 and 2, or length of hospital stays between the 2 groups. However, the ICA group had a significantly shorter time to first flatus passage (3.0 ± 0.9 days vs. 3.8 ± 1.9 days, P = 0.013). The rate of postoperative ileus was significantly higher in the ECA group (2.2% vs. 14.3%, P = 0.033); however, there was no significant difference in the overall morbidity within 30 days after surgery. Multivariate logistic regression analysis showed that the ECA technique (odds ratio [OR], 0.098; 95% confidence interval [CI]; 0.011–0.883, P = 0.038) and previous abdominal operation (OR, 5.269; 95% CI, 1.193–23.262; P = 0.028) were independent risk factors for postoperative ileus.
Conclusion
The postoperative outcomes of patients who underwent LRC with ICA or ECA were comparable, and ICA could reduce the incidence of postoperative ileus after LRC compared with ECA.

Keyword

Ileus; Laparoscopy; Multivariate analysis; Risk factors; Surgical anastomosis

Figure

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  Fig. 1 Anastomotic techniques in right colectomy. (A) Extracorporeal end-to-side anastomosis using a circular stapler. (B) Intracorporeal side-to-side anastomosis using a linear stapler.

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