Jarry Cristián, Cárcamo Leonardo, González Juan José, Bellolio Felipe, Miguieles Rodrigo, Urrejola Gonzalo, Zúñiga Alvaro, Crovari Fernando, Molina María Elena, Larach José Tomás
Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Fourth Floor, Santiago, Chile.
Intern, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Updates Surg. 2021 Feb;73(1):93-100. doi: 10.1007/s13304-020-00840-4. Epub 2020 Jun 30.
Reconstruction after laparoscopic right colectomy (LRC) can be achieved by performing an intracorporeal (IA) or an extracorporeal anastomosis (EA). This study aims to assess the safety of implementing IA in LRC, and to compare its perioperative outcomes with EA during an institution's learning curve. Patients undergoing elective LRC with IA or EA in a teaching university hospital between January 2015 and December 2018 were included. Demographic, clinical, perioperative and histopathological data were collated and outcomes investigated. One hundred and twenty-two patients were included; forty-three (35.2%) had an IA. The main indication for surgery was cancer in both groups (83.7% for IA and 79.8% for EA; p = 0.50). Operative time was longer for IA (180 [150-205] versus 150 [120-180] minutes; p < 0.001). A Pfannenstiel incision was used as extraction site in 97.7% of patients receiving an IA; while a midline incision was used in 97.5% of patients having an EA (p < 0.001). Hospital stay was significantly shorter for IA (3 [3, 4] versus 4 [3-6] days; p = 0.003). There were no differences in postoperative complications rates between groups. There was a 4.7% and 3.8% anastomotic leak rate in the IA and EA group, respectively (p = 1). Re-intervention and readmission rates were similar between groups, and there was no mortality during the study period. The implementation of IA in LRC is safe. Despite longer operative times, IA is associated with a shorter hospital stay when compared to EA in the setting of an institution's learning curve.
腹腔镜右半结肠切除术（LRC）后的重建可通过体内（IA）或体外吻合术（EA）来实现。本研究旨在评估LRC中实施IA的安全性，并在机构的学习曲线期间将其围手术期结果与EA进行比较。纳入2015年1月至2018年12月在一所教学大学医院接受IA或EA的择期LRC患者。整理人口统计学、临床、围手术期和组织病理学数据并调查结果。共纳入122例患者；43例（35.2%）接受IA。两组手术的主要指征均为癌症（IA组为83.7%，EA组为79.8%；p = 0.50）。IA组的手术时间更长（180[150 - 205]分钟对150[120 - 180]分钟；p < 0.001）。97.7%接受IA的患者采用Pfannenstiel切口作为取出部位；而97.5%接受EA的患者采用中线切口（p < 0.001）。IA组的住院时间明显更短（3[3, 4]天对4[3 - 6]天；p = 0.003）。两组术后并发症发生率无差异。IA组和EA组的吻合口漏率分别为4.7%和3.8%（p = 1）。两组的再次干预和再入院率相似，研究期间无死亡病例。LRC中实施IA是安全的。尽管手术时间更长，但在机构学习曲线背景下，与EA相比，IA与更短的住院时间相关。
