A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy.
OBJECTIVE
Two main techniques are commonly used during laparoscopic right hemicolectomy in order to perform the ileocolic anastomosis: intracorporeal (IA) and extracorporeal (EA). The aim of this study was to evaluate the safety of the two techniques.


METHODS
A systematic review was carried out to identify studies comparing IA and EA. The primary endpoint was anastomotic leakage. The secondary endpoints were intra- and postoperative results. A meta-analysis was carried out using the random-effects model.


RESULTS
Fourteen studies matched the selection criteria, enrolling 1717 patients (50.3 % IA, 49.7 % EA). The anastomotic leakage was similar in the IA and the EA groups (3.4 vs. 4.6 %, respectively) with a risk difference (RD) of -0.01 (95 % CI = -0.03 to 0.01; P = 0.120). IA group had lower overall complication rate (27.6 vs. 38.4 %; RD = -0.15; 95 % CI = 0.27 to -0.04; P = 0.009) and wound infection rate (4.9 vs. 8.9 %; RD = 0.52; -0.03; 95 % CI = -0.06 to -0.01; P = 0.030). Time to first oral intake (weighted mean difference (WMD) = -1; 95 % CI = -1.59 to -0.41; P < 0.001), length of hospital stay (WMD = -1.13; 95 % CI = -1.90 to -0.35; P = 0.004) and minilaparotomy size (WMD = -26; 95 % CI = -38 to -13; P < 0.001) were shorter in IA patients. The incisional hernia rate was lower in the IA group (2.3 vs. 13.7 %) with an RD of -0.09 (95 % CI = -0.17 to -0.02; P = 0.020). There were no differences in operative time, blood loss, conversion, internal hernia, reoperation, mortality, time to first flatus and defecation, analgesic required, number of lymph nodes harvested and length of distal margin.


CONCLUSIONS
Laparoscopic right hemicolectomy with IA is a safe alternative to EA. Additional well-structured, prospective randomised trials are needed to confirm all the advantages regarding postoperative results which were pointed out in our study.
Department of Internal Medicine and Surgery, (DIMEC) Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. claudiochir@gmail.com.|Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy. claudiochir@gmail.com.
Claudio
C
Ricci
Department of Internal Medicine and Surgery, (DIMEC) Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Riccardo
R
Casadei
Department of Internal Medicine and Surgery, (DIMEC) Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Vincenzo
V
Alagna
Department of Internal Medicine and Surgery, (DIMEC) Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Elia
E
Zani
Department of Internal Medicine and Surgery, (DIMEC) Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Giovanni
G
Taffurelli
Department of Internal Medicine and Surgery, (DIMEC) Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Carlo Alberto
CA
Pacilio
Department of Internal Medicine and Surgery, (DIMEC) Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Francesco
F
Minni
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003106:Colon / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*
Colorectal; Laparoscopy; Outcomes; Patient safety