Intracorporeal vs extracorporeal anastomosis following neoplastic right hemicolectomy resection: a systematic review and
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REVIEW
Intracorporeal vs extracorporeal anastomosis following neoplastic right hemicolectomy resection: a systematic review and meta-analysis of randomized control trials B. Creavin 1,2
&
I. Balasubramanian 2 & M. Common 1,2 & C. McCarrick 1 & S. El Masry 1,2 & E. Carton 1,2 & E. Faul 1,2
Accepted: 20 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose While minimally invasive surgery is the preferred approach for right hemicolectomy, the choice of anastomotic technique is still debated. Both intracorporeal (ICA) and extracorporeal anastomosis (ECA) are described, with conflicting reports on safety and efficacy seen. This study aimed to examine impact of ICA and ECA on outcomes in right hemicolectomy. Methods A meta-analysis of randomized control trials (RCT) was performed. The primary outcome was overall morbidity. The secondary outcomes included both perioperative and post-operative outcomes. Results Four RCTs were included incorporating 399 patients (199 patients (49.9%) ICA Vs 200 (50.1%) ECA). There was no significant difference in overall morbidity (RR 0.79, 95% CI 0.43, 1.48, p = 0.47), anastomotic leak (RR 1.34, 95% CI 0.58, 3.13, p = 0.5) or surgical site infections (RR 0.53, 95% CI 0.17, 1.64, p = 0.27). ICA patients had a significantly less post-operative ileus (RR 0.53, 95% CI 0.3–0.94, p = 0.03) quicker return to first flatus (WMD − 0.71, 95% CI − 1.12, 0.31, p = 0.0005), first bowel motion (WMD − 0.53, 95% CI − 0.69, − 0.37, p < 0.00001) and first meal (WMD − 0.68, 95% CI − 1.33, − 0.03, p = 0.04). Pain scores were significantly better for ICA patients on POD 3 (WMD − 0.76, 95% CI − 1.23, − 0.28, p = 0.002), POD 4 (WMD − 0.90, 95% CI − 1.71, − 0.09, p = 0.03) and POD 5 (WMD − 0.67, 95% CI − 1.22, − 0.13, p = 0.01). Length of hospital stay was similar (WMD − 0.46, 95% CI − 1.14, 0.22, p = 0.19). Conclusion ICA is associated with a quicker return to normal physiological function with equivalent post-operative morbidity. Both ECA and ICA are safe and feasible for restoring normal bowel continuity. Keywords Intracorporeal . Extracorporeal . Anastomosis . Colectomy . Meta-analysis . Randomized control trial
Introduction Minimally invasive surgery (MIS) is increasingly becoming the preferred surgical approach for right colectomies [1–3]. MIS is associated with improved post-operative pain, return to normal bowel function and shorter hospital stay, and is increasingly being incorporated into enhanced recovery protocols [4–6].
* B. Creavin [email protected] 1
Department of Surgery, Our Lady of Lourdes Hospital Drogheda, Windmill Road, Moneymore, Drogheda, Co Louth, Ireland
2
Royal College of Surgeons, 123 St Stephens Green, Saint Peter’s, Dublin, Ireland
While MIS is becoming the standard of care in colorectal surgery, the choice of anastomotic technique is still debated. The traditional extracorporeal anastomosis (ECA) involves exteriorization of the bowel in order to restore normal bowel continuity, while an intracorporeal anastomosis (ICA) allows for res
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