Laparoscopic right colectomies with intracorporeal compared to extracorporeal anastomotic techniques are associated with reduced post-operative incisional hernias,Surgical Endoscopy

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Laparoscopic right colectomies with intracorporeal compared to extracorporeal anastomotic techniques are associated with reduced post-operative incisional hernias
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-10-03 , DOI: 10.1007/s00464-022-09585-0
Sydney Selznick ₁ , Jordan Levy ₁ , Ruxandra-Maria Bogdan ₁ , Jeffrey Hawel ₁ , Ahmad Elnahas ₁ , Nawar A Alkhamesi ₁ , Christopher M Schlachta ₁

Affiliation

Background

Owing to important differences in surgical technique, laparoscopic right colectomy with intracorporeal (ICA) compared to extracorporeal (ECA) anastomotic technique may result in improved patient outcomes. We aimed to compare both techniques according to incisional hernias and other pertinent perioperative characteristics, post-operative complications, and oncologic quality markers.

Methods

All adult patients undergoing laparoscopic right colectomies between 2015 and 2020 at a single institution were included. ICA and ECA techniques were compared based on selected outcomes using univariable and multivariable statistical analyses, as appropriate. Subgroup analyses were restricted to patients with neoplastic indications for surgery and non-urgent operations.

Results

A total of 517 patients met inclusion criteria, of which 139 (26.9%) underwent ICA and 378 (73.1%) underwent ECA. ICA and ECA patients had similar baseline characteristics. At two years of follow-up, a lower proportion of ICA patients developed a hernia at the extraction incision (1.5% vs. 7.1%, p = 0.02) and ICA was associated with an 80% reduction in extraction incision hernias (aHR 0.20, p = 0.03). These results were stable through subgroup and sensitivity analyses. Median operative time was longer in the ICA group (186 min vs. 135 min, p < 0.001), but the gap in operative time narrowed during the study period. Median length of stay was one calendar day shorter in the ICA group (3 days vs. 4 days, p = 0.007) and ICA was associated with a 13% decrease in the length of stay (aRR 0.87, p = 0.02). The incidence of superficial wound infections, anastomotic leaks and re-interventions was lower in ICA patients, but this difference was not statistically significant. 90-day unscheduled visits, readmissions, and mortalities were similar across both groups, as were oncologic outcomes.

Conclusion

Laparoscopic right colectomies with intracorporeal anastomoses are associated with a reduction in incisional hernias and shorter hospital lengths of stay without compromising on patient safety or oncologic principles.

Graphical abstract

中文翻译：

与体外吻合技术相比，腹腔镜右侧结肠切除术与体外吻合技术可减少术后切口疝的发生

背景

由于手术技术的重要差异，与体外（ECA）吻合技术相比，腹腔镜右结肠切除术采用体内（ICA）吻合技术可能会改善患者的预后。我们的目的是根据切口疝和其他相关围手术期特征、术后并发症和肿瘤质量标志物来比较这两种技术。

方法

2015 年至 2020 年期间在同一机构接受腹腔镜右结肠切除术的所有成年患者均被纳入。根据选定的结果，酌情使用单变量和多变量统计分析来比较 ICA 和 ECA 技术。亚组分析仅限于有肿瘤手术指征和非紧急手术的患者。

结果

共有 517 例患者符合纳入标准，其中 139 例（26.9%）接受了 ICA，378 例（73.1%）接受了 ECA。 ICA 和 ECA 患者具有相似的基线特征。在两年的随访中，ICA 患者在拔牙切口处出现疝气的比例较低（1.5% vs. 7.1%， p = 0.02），并且 ICA 与拔牙切口疝气减少 80% 相关（aHR 0.20， p = 0.03）。通过亚组和敏感性分析，这些结果是稳定的。 ICA 组的中位手术时间较长（186 分钟 vs. 135 分钟， p < 0.001），但在研究期间手术时间差距缩小。 ICA 组的中位住院时间缩短了 1 个日历日（3 天与 4 天， p = 0.007），并且 ICA 与住院时间减少 13% 相关（aRR 0.87， p = 0.02）。 ICA患者浅表伤口感染、吻合口瘘和再次干预的发生率较低，但这种差异无统计学意义。两组的 90 天计划外就诊、再入院和死亡率以及肿瘤学结果相似。