Intracorporeal versus extracorporeal anastomosis for right colectomy does not affect gastrointestinal recovery within an
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and Other Interventional Techniques
2019 SAGES ORAL
Intracorporeal versus extracorporeal anastomosis for right colectomy does not affect gastrointestinal recovery within an enhanced recovery after surgery program Maude Trépanier1,2 · Anthony Valin‑Thorburn3 · Araz Kouyoumdjian3 · Teodora Dumitra1,2 · Mohsen Alhashemi1,2 · Pepa Kaneva2 · A. Sender Liberman1,2 · Patrick Charlebois1,2 · Barry S. Stein1,2 · Gerald M. Fried1,2 · Liane S. Feldman1,2 · Lawrence Lee1,2 Received: 8 April 2019 / Accepted: 9 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Introduction Delayed gastrointestinal (GI) recovery remains a significant morbidity after colorectal surgery. Intracorporeal anastomosis for right colectomy may hasten GI recovery. Therefore, the objective of this study was to determine the effect of intracorporeal versus extracorporeal anastomosis on GI recovery after elective laparoscopic right colectomy within an established ERAS program. Methods Adult patients undergoing elective laparoscopic right colectomy at a single high-volume institution from 07/2014 to 12/2018 were reviewed. Patients were divided into two groups: intracorporeal (IC) and extracorporeal (EC). The primary outcome was time to GI-3 defined as days to tolerance of solid diet and first flatus/bowel movement. Prolonged postoperative ileus (PPOI) was defined as GI-3 not met by postoperative day 4. Secondary outcomes were length of stay (LOS) and overall 30-day complications. Sensitivity analysis was performed using coarsened exact matching to account for unmeasured confounding. Multiple regression was performed using a Cox proportional hazard model to identify predictors of GI recovery. Results A total of 346 patients were reviewed, of which 226 were included (71IC, 155EC). Patient characteristics were well balanced between groups: mean age was 64.9 years (SD 15.9), BMI was 26.3 (SD 5.7), 38.1% of patients had ASA ≥ 3, and 78.3% underwent surgery for neoplasms. IC anastomosis was associated with longer operative duration (165 min (SD 40); 144 min (SD 48), p = 0.002). There was no difference in the median time to GI-3 (IC 2 days [IQR1-2]; EC 2 days [IQR2-3], p = 0.135). The incidence of PPOI (IC 8.5%; EC 10.3%, p = 0.659), superficial SSI (4.2% vs. 5.8%, p = 0.757), deep SSI (2.8% vs. 5.2%, p = 0.729), and median LOS (3 days [IQR 2–4] vs. 3 [IQR 3–5], p = 0.059) were also similar. On multivariate analysis, IC anastomosis did not independently predict faster GI recovery (HR 0.98, 95% CI 0.71–1.34). Similar results were observed in the matched cohort (185 patients (61IC, 124EC)). Conclusion In this study, IC anastomosis was not associated with faster GI recovery or reduced complication rate compared to EC anastomosis. Longer term studies may be required to determine the potential benefits of IC anastomosis. Keywords Intracorporeal anastomosis · Gastrointestinal recovery · Colorectal surgery · Extracorporeal anastomosis · Ileus · Ileocolic anastomosis
* Lawrence Lee [email protected] 1
Department of S
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