title: Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis.
abstract: Laparoscopic right colectomy with intracorporeal anastomosis is a procedure of increasing popularity. This study aims to compare short- and long-term outcomes of intracorporeal and extracorporeal anastomoses.
  
  
  
  This is a comparative study of two anastomosis techniques for laparoscopic right hemicolectomy. A total of 191 consecutive patients, operated for neoplasm of the right colon, were identified. The intracorporeal group included 91 patients and the extracorporeal group 100 patients.
  
  
  
  Patient demographics and disease-related characteristics were similar. Mean operative time was longer in the intracorporeal group (155 vs. 142 min; P = 0.006). Intracorporeal anastomosis was associated with less overall postoperative complications (18.7 vs. 35 %, P = 0.011) and decreased rate of surgical site infections (4.4 vs. 14 %, P = 0.023). The need for postoperative intervention (Clavien-Dindo 3) was higher in the extracorporeal group (7 vs. 0 %; P = 0.015). There was no statistically significant difference in the incidence of postoperative leak, ileus and bleeding. Mean length of stay was significantly shorter in the intracorporeal group (5.9 ± 2.1 vs. 6.9 ± 3.0; P = 0.04). Moreover, more patients with intracorporeal anastomosis had a length of stay shorter than 4 days (28.6 vs. 14.1 %, P = 0.015). Extraction incision was periumbilical in 99 % of the patients in the extracorporeal group. In the intracorporeal group extraction, incision was transverse suprapubic (Pfannenstiel) in 85.7 %, transvaginal in 9.9 % and periumbilical in 3.3 % of the patients. The incidence rate of incisional hernia was lower in the intracorporeal group (2.2 vs. 17.0 %, P = 0.001).
  
  
  
  Laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short- and long-term outcomes. The rates of postoperative complications requiring intervention and incisional hernias are decreased.
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel Aviv, Israel. ron.shapiro@sheba.health.gov.il.
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel Aviv, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Keler
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel Aviv, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Segev
authors.affiliation: Department of Surgery B, Carmel Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Stav
authors.initials: S
authors.lastname: Sarna
authors.affiliation: Department of Surgery B, Carmel Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Kamal
authors.initials: K
authors.lastname: Hatib
authors.affiliation: Department of Surgery B, Carmel Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Hazzan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D000069290:Incisional Hernia / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology
keywords: Incisional hernia; Intracorporeal anastomosis; Laparoscopic right colectomy