Kwiatkowski Andrzej P, Stępińska Gabriela, Stanowski Edward, Paśnik Krzysztof, Janik Michal R
Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland.
First Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2019 Sep;14(3):381-386. doi: 10.5114/wiitm.2019.81725. Epub 2019 Jan 30.
Nowadays laparoscopic right hemicolectomy is widely accepted as the standard of care for benign and malignant colon disease. There are wide variations among laparoscopic techniques. One of the most discussed topics is the ileocolic anastomosis. There are two different techniques: intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA).
To compare short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy.
A retrospective chart review was performed of 92 consecutive patients who underwent laparoscopic right hemicolectomy, with either an IA or EA, from January 2013 to December 2016.
Eighty-five patients were included in the analysis. There were 53 males and 32 females with a mean age of 67.1 ±13.2 years. Mean body mass index (BMI) was 27.7 ±4.8 kg/m. An intracorporeal anastomosis was performed in 51 patients, while an extracorporeal anastomosis was performed in 34. The duration of operations was significantly longer when intracorporeal anastomosis was performed, taking 154 ±58 min compared to 95 ±34 min (p < 0.001), in the extracorporeal group. No mortality was observed in the IA group. The postoperative mortality in the EA group was 8.8% (p = 0.060). The rate of reoperation in the intracorporeal anastomosis group was 7.8%, whereas in the extracorporeal anastomosis group it was 14.7% (p = 0.474). Length of hospital stay in the IA group was shorter in comparison to the EA group (5.3 ±3.7 vs. 11.2 ±19.8 days, p = 0.022).
Our results are encouraging to consider the intracorporeal approach as the better way to fashion the anastomosis after laparoscopic right hemicolectomy.
如今，腹腔镜右半结肠切除术已被广泛认可为治疗良性和恶性结肠疾病的标准术式。腹腔镜技术存在很大差异。讨论最多的话题之一是回结肠吻合术。有两种不同的技术：体内吻合术（IA）和体外吻合术（EA）。
比较腹腔镜右半结肠切除术中进行体内吻合与体外吻合的短期疗效。
对2013年1月至2016年12月期间连续92例行腹腔镜右半结肠切除术且采用IA或EA的患者进行回顾性病历分析。
85例患者纳入分析。其中男性53例，女性32例，平均年龄67.1±13.2岁。平均体重指数（BMI）为27.7±4.8kg/m²。51例患者行体内吻合术，34例患者行体外吻合术。与体外吻合组的95±34分钟相比，进行体内吻合术时手术时间明显更长，为154±58分钟（p<0.001）。IA组未观察到死亡病例。EA组术后死亡率为8.8%（p=0.060）。体内吻合术组的再次手术率为7.8%，而体外吻合术组为14.7%（p=0.474）。与EA组相比，IA组的住院时间更短（5.3±3.7天对11.2±19.8天，p=0.022）。
我们的结果表明，腹腔镜右半结肠切除术后采用体内吻合方式是更好的选择，令人鼓舞。
