Frigault Jonathan, Avoine Samuel, Drolet Sébastien, Letarte François, Bouchard Alexandre, Gagné Jean-Pierre, Thibault Claude, Grégoire Roger C, Bouthillette Naomee Jutras, Gosselin Maude, Bouchard Philippe
Department of Surgery, Laval University, Québec, QC, Canada.
Ann Coloproctol. 2023 Apr;39(2):147-155. doi: 10.3393/ac.2021.00983.0140. Epub 2022 Mar 29.
Laparoscopic right hemicolectomy (LRH) can be performed with an intracorporeal anastomosis (IA) or extracorporeal 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.
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.
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 frequency 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.
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.
腹腔镜右半结肠切除术（LRH）可采用体内吻合（IA）或体外吻合（EA）。目前尚不清楚哪种技术最佳。本研究评估了每种吻合技术对围手术期安全性和术后恢复的影响。
我们在一家三级结直肠手术中心进行了一项回顾性研究。根据所采用的吻合技术，对2015年至2019年期间所有接受择期LRH的患者进行分析。
本研究共纳入285例患者。64例患者（22.5%）采用IA。IA组患者的平均手术时间更长（IA组为160±31分钟，EA组为138±42分钟；P<0.001）。术中并发症、首次排便时间、住院时间、再次手术或再次住院方面未观察到差异。IA组患者首次排气时间更长（P=0.049）。术后30天，吻合口漏发生率（IA组为0%，EA组为2.3%；P=0.59）、出血发生率（IA组为3.1%，EA组为2.7%；P>0.99）或腹腔内脓肿发生率（IA组为0%，EA组为0.5%；P>0.99）无差异。在随访期间，我们注意到EA组患者的切口疝更多（IA组为1.6%，EA组为11.3%；P=0.01），多因素分析显示EA组患者发生疝的趋势更明显（风险比为7.13；P=0.06）。吻合技术对复发无影响。
对于LRH，IA和EA都是安全的，由经验丰富的外科医生进行时并发症发生率较低。IA可能与较低的切口疝发生率相关。
