title: Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastamosis: a comparison of short-term outcomes.
abstract: BACKGROUND
  There is wide variation among laparoscopic colon resection techniques, including the approach for mobilization and the extent of intracorporal vessel ligation, bowel division or anastamosis. We compared the short-term outcomes of laparoscopic right hemicolectomy (LRHC) with intracorporeal (IA) versus extracorporeal (EA) anastamosis.
  
  
  METHODS
  We retrospectively reviewed all elective laparoscopic right hemicolectomies performed at St. Joseph's Hospital between January 2008 and September 2009 and compared the demographic, pathologic, operative and outcome data.
  
  
  RESULTS
  Fifty LRHCs were completed during the study period: 21 IA and 29 EA. The groups were similar in age, sex, body mass index, American Society of Anesthesiologists score, previous laparotomy and preoperative invasive pathology. There was no difference between IA and EA in mean duration of surgery (170 v. 181 min, p = 0.78), estimated blood loss (14 v. 42 mL, p = 0.15), perioperative blood transfusions (5% v. 14%, p = 0.29), in-hospital morbidity (33% v. 41%, p = 0.56), out-of-hospital morbidity (19% v. 31% p = 0.34), emergency department visits (10% v. 17%, p = 0.16) or 30-day readmissions (5% v. 7%, p = 0.75). There was 1 anastamotic leak in each group and no perioperative deaths. Median length of stay was significantly shorter for IA (4 v. 5 d, p = 0.05). There were 6 extraction site hernias with EA and none with IA (p = 0.026).
  
  
  CONCLUSIONS
  Laparoscopic right hemicolectomy with IA has the advantage of a less hernia-prone Pfannenstiel extraction site, faster recovery and shorter stay in hospital EA.
authors.affiliation: The Division of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man.
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Vergis
authors.affiliation: The Division of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Steigerwald
authors.affiliation: The Department of Surgery, Guelph General Hospital, Guelph, Ont.
authors.forename: Faizal D
authors.initials: FD
authors.lastname: Bhojani
authors.affiliation: The Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ont.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sullivan
authors.affiliation: The Division of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man.
authors.forename: Krista M
authors.initials: KM
authors.lastname: Hardy
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies