Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study of anastomotic complications

Purpose: Laparoscopic right hemicolectomy (LRH) can be performed with an intracorporeal anastomosis (IA) or extra-corporeal anastomosis (EA). It is not clear which technique is best. This study evaluated the impact of each anastomosis technique on perioperative safety and postoperative evolution.Methods: We performed a retrospective study at a tertiary colorectal surgery center. All patients who had an elective LRH from 2015 to 2019 were analyzed according to the anastomosis technique used.Results: In total, 285 patients were included in the study. IA was performed in 64 patients (22.5%). Mean operative time was longer in the patients with IA (IA, 160 +/- 31 minutes vs. EA, 138 +/- 42 minutes; P < 0.001). No differences were observed in intraoperative complications, time to first bowel movement, length of stay, reoperation, or rehospitalization. Time to first flatus was longer in the patients with IA (P = 0.049). At 30 days after surgery, there were no differences in the fre-quency of anastomotic leak (IA, 0% vs. EA, 2.3%; P =0.59), bleeding (IA, 3.1% vs. EA, 2.7%; P> 0.99), or intraabdominal abscess (IA, 0% vs. EA, 0.5%; P > 0.99). During follow-up, we noted more incisional hernias in patients with EA (IA, 1.6% vs. EA, 11.3%; P = 0.01) and a trend toward more hernia in patients with EA in multivariate analysis (hazard ratio, 7.13; P = 0.06). Anastomosis technique had no influence on recurrence. Conclusion: For LRH, both IA and EA are safe, with a low incidence of complications when performed by experienced surgeons. IA may be associated with a lower incidence of incisional hernia.