The impact of intracorporeal anastomosis in right laparoscopic colectomy in the surgical site infections and the hospital stay: a cohort study

Abstract

Ileocolic anastomosis in laparoscopic-assisted right colectomy is frequently performed extracorporeally. Intracorporeal anastomosis could be associated with several short-term benefits. However, it is a more technically demanding procedure. The primary endpoint of the study aimed to evaluate the postoperative surgical-site infection rate and its impact on the length of hospital stay after laparoscopic right colectomy with intracorporeal anastomosis compared to extracorporeal anastomoses. Between 2010 and 2019, 108 unselected consecutive patients underwent right colectomy. An observational comparative cohort study of two anastomosis techniques, intracorporeal (IA) versus extracorporeal (EA), was conducted. Data were extracted from a prospectively maintained colorectal surgery database of a university-affiliated hospital and retrospectively analyzed. The main exclusion criteria were emergency surgery and medical or anesthetic contraindication for laparoscopy. 53 patients underwent right colectomy with IA, and 55 had extracorporeal anastomoses. The groups did not differ in demographics, anesthetic risk, intraoperative data, pathological outcomes, or overall survival. Mean operative time was longer in the IA group (156.9 vs. 146.0 min; p\u2009=\u20090.061). A significant reduction in the anastomotic leak rate was observed in the IA group compared with the EA group (0 vs. 7.3%; p\u2009=\u20090.045) with no differences in the intraabdominal abscess rate (IA: 1.9% vs. EA: 1.8%; p\u2009=\u20090.97). The wound infection rate was 5.7% for IA and 10.9% for EA (p\u2009=\u20090.324). The hospital stay was significantly shorter for those who had intracorporeal anastomoses (5.2\u2009±\u20093.3 vs. 10.8\u2009±\u20099.6 days; p\u2009=\u20090.000). Right colectomy with intracorporeal anastomosis was associated with less surgical-site infections and a significantly shorter hospital stay than EA technique. Surgeons should consider the IA as the first option when performing laparoscopic right colectomy. Registration number: NCT04350203 (http://www.clinicaltrials.gov).