Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: results from the CLIMHET study gro
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ORIGINAL ARTICLE
Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: results from the CLIMHET study group N. Bou Saleh1 · T. Voron8 · N. De’Angelis4 · I. Franco2,3 · F. Canoui‑Poitrine5,6 · D. Mutter3 · F. Brunetti4 · J. Gagnière1 · R. Memeo2,3 · D. Pezet1 · B. Monange9 · B. Pereira7 · B. Le Roy1 Received: 23 April 2019 / Accepted: 30 March 2020 © Springer Nature Switzerland AG 2020
Abstract Background Laparoscopic right hemicolectomy (LRHC) is increasingly performed for the treatment of right colon disease. Nevertheless, standardization of the surgical technique regarding the performance of intracorporeal (IC) or extracorporeal (EC) anastomosis is lacking. The purpose of this study was to compare short-term postoperative outcomes in patients who had laparoscopic right colectomy either with IC or EC. Methods This was a retrospective, non-randomized and multicenter study conducted from January 2005 to December 2015 on the CLIMHET study group cohort from five tertiary centers in France. Data were collected for all patients with LRHC to compare patient characteristics, intraoperative data and postoperative outcomes in terms of medical and surgical complications, duration of hospitalization and mortality. A multivariate analysis was performed to compare the results in the two groups. Results Of the 597 patients undergoing LRHC, 150 had IC and 447 had EC. The incidence of medical complications (cardiac, vascular, and pulmonary complications) was lower in the IC group than in the EC group (13 vs 20%, p = 0.049). This difference remained significant in multivariate analysis after adjusting to field characteristics and patient histories (p = 0.009). Additionally, a shorter hospital stay (7 vs 8 days, p = 0.003) was observed in the IC group as compared to the EC group. This difference remained significant in favor of the IC group in multivariate analysis (p = 0.029). There was no difference between the groups as regards: surgical complications (p = 0.76), time of mobilization (p = 0.93), reintervention rate (p = 1) and 90-day mortality (p = 0.47). Conclusions Our results show that IC anastomosis in LRHC is associated with fewer medical complications and shorter hospital stays compared to EC anastomosis. Keywords Intracorporeal · Extracorporeal · Anastomosis · Colectomy · Outcome
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Biostatistics Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
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CEpiA EA7376, DHU Ageing-Thorax-Vessel-Blood, Université Paris Est (UPEC), Créteil, France
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Department of Emergency and Organ Transplantation, Azienda Ospedaliero-Universitaria, Bari, Italy
Clinical Research and Innovation Delegation (DRCI), CHU Clermont-Ferrand, Clermont‑Ferrand, France
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Hepato-Biliary and Pancreatic Surgical Unit, IRCAD-IHU, University of Strasbourg, Strasbourg, France
Department of Digestive Surgery, Georges Pompidou European Hospital, Paris, France
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Medical Department, Emile Roux Hospital, Puy‑en‑Velay, France
* B. Le Roy [email protected] 1
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