UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy.
Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
JSLS. 2022 Jul-Sep;26(3). doi: 10.4293/JSLS.2022.00039.
To compare the outcomes of extracorporeal hand-sewn side-to-side isoperistaltic ileocolic anastomosis (EHSIA) versus intracorporeal mechanic side-to-side isoperistaltic ileocolic anastomosis (IMSIA) during laparoscopic right hemicolectomy for adenocarcinoma.
This is a retrospective propensity score-matched analysis of prospectively collected data. Fifty-four patients who underwent surgery with EHSIA (intervention group) were paired with 54 patients who underwent surgery with IMSIA (control group) based on patients' demographics and type of surgery (standard right hemicolectomy or extended right hemicolectomy).
Fifty-four patients were included for each group. Statistically significant differences between groups were not observed in patients' demographics and type of surgery. Conversion occurred in three patients of the intervention group due to intra-abdominal adhesions for previous surgery (5.6%) (p = 0.079). Median operative time was statistically significant shorter in the control group in comparison to the intervention group (85 and 117.5 minutes, respectively, p ≤ 0.0001). In both groups one anastomotic leakage was observed (1.9%) (Clavien-Dindo grade III-a). In the control group one patient (1.9%) underwent reintervention for acute postoperative anemia (Clavien-Dindo grade III-b). Median number of harvested lymph-nodes was 17 and 12 (p ≤ 0.0001), in the intervention and the control group, respectively. Median hospital stay was statistically significant lower in the control group in comparison to the intervention group (5 and 6.5 days, respectively, p ≤ 0.013).
IMSIA showed lower operative time and hospital stay in comparison to EHSIA. Further randomized studies are required to draw definitive conclusions about the best anastomotic technique during laparoscopic right hemicolectomy.
比较腹腔镜右半结肠切除术治疗腺癌时，体外手工侧侧等蠕动吻合（EHSIA）与体内机械侧侧等蠕动吻合（IMSIA）的结果。
这是一项回顾性倾向评分匹配分析，对前瞻性收集的数据进行分析。根据患者的人口统计学和手术类型（标准右半结肠切除术或扩展右半结肠切除术），将接受 EHSIA 手术的 54 例患者（干预组）与接受 IMSIA 手术的 54 例患者（对照组）配对。
每组纳入 54 例患者。两组患者的人口统计学和手术类型无统计学差异。由于先前手术的腹腔粘连，干预组有 3 例患者转为手术（5.6%）（p=0.079）。与干预组相比，对照组的手术时间明显缩短（分别为 85 和 117.5 分钟，p≤0.0001）。两组均有 1 例吻合口漏（1.9%）（Clavien-Dindo 分级 III-a）。在对照组中，有 1 例患者（1.9%）因急性术后贫血而行再干预（Clavien-Dindo 分级 III-b）。干预组和对照组分别采集的淋巴结中位数为 17 个和 12 个（p≤0.0001）。与干预组相比，对照组的中位住院时间明显降低（分别为 5 和 6.5 天，p≤0.013）。
与 EHSIA 相比，IMSIA 显示出较低的手术时间和住院时间。需要进一步的随机研究来确定腹腔镜右半结肠切除术最佳吻合技术的结论。
