Khalid Aizaz, Tan Jessica, Ali Syed Mohammed
General Surgery, University Hospitals Sussex NHS Foundation Trust, Chichester, GBR.
Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Chichester, GBR.
Cureus. 2023 Aug 27;15(8):e44194. doi: 10.7759/cureus.44194. eCollection 2023 Aug.
Right hemicolectomy is a commonly performed procedure for both benign and malignant diseases of the right colon. However, there is marked technical variation in the anastomosis technique used. In our hospital, both intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) are performed. Our study aimed to assess and compare the short-term outcomes following laparoscopic right hemicolectomies, particularly in regard to the anastomosis technique.
All consecutive adult (>18 years of age) patients who underwent elective right hemicolectomy from January 2020 to April 2023 at St Richards Hospital, Chichester, University Hospitals Sussex NHS Foundation Trust, UK, were included in our retrospective study. Data, including age at operation, body mass index, American Society of Anesthesiologists (ASA) score, pathology, type of procedure, type of anastomosis, technique of anastomosis, post-operative high-dependency unit (HDU) stay, hospital length of stay, post-operative ileus, anastomotic leak, return to theater, and in-hospital mortality, were extracted. Patients who did not get an ileocolic anastomosis, had a stoma formation, and had an open procedure or conversion to open procedure were excluded. The cases that fulfilled the criteria were shortlisted for analysis. These cases were then divided into two groups: patients who had an IA and those who had an EA.
From January 2020 to April 2023, 152 patients underwent right hemicolectomy. A total of 139 patients fulfilled our eligibility criteria and were included in our final analysis. The overall mortality rate was 0.7% (1/139), the return to theater rate was 0.7% (1/139), and no anastomotic leaks were recorded. The overall ileus rate was 16.5% (23/139). The hospital length of stay was significantly longer in the EA group as compared to the IA group (p<0.004). A higher proportion (18.75%, n=21) of the patients had a recorded ileus in the EA group as compared to 7.4% (n=2) in the IA group, but this difference was not statistically significant (p=0.24).
We found that the patients who had IA had reduced hospital length of stay. The IA group also had clinically significant reduced rates of post-operative ileus, but this was not statistically significant. However, other short-term outcomes that were measured were similar in both groups.
右半结肠切除术是治疗右半结肠良恶性疾病的常用手术。然而，所采用的吻合技术存在显著的技术差异。在我们医院，既进行体内吻合（IA），也进行体外吻合（EA）。我们的研究旨在评估和比较腹腔镜右半结肠切除术后的短期结局，特别是在吻合技术方面。
纳入2020年1月至2023年4月在英国奇切斯特圣理查兹医院、苏塞克斯大学医院国民保健服务基金会信托接受择期右半结肠切除术的所有连续成年（>18岁）患者，进行回顾性研究。提取的数据包括手术年龄、体重指数、美国麻醉医师协会（ASA）评分、病理、手术类型、吻合类型、吻合技术、术后高依赖病房（HDU）住院时间、住院时间、术后肠梗阻、吻合口漏、返回手术室情况及院内死亡率。未进行回结肠吻合、行造口术以及进行开放手术或转为开放手术的患者被排除。符合标准的病例被筛选出来进行分析。这些病例随后被分为两组：接受IA的患者和接受EA的患者。
2020年1月至2023年4月，152例患者接受了右半结肠切除术。共有139例患者符合纳入标准并纳入最终分析。总体死亡率为0.7%（1/139），返回手术室率为0.7%（1/139），未记录到吻合口漏。总体肠梗阻发生率为16.5%（23/139）。与IA组相比，EA组的住院时间显著更长（p<0.004）。EA组有记录的肠梗阻患者比例更高（18.75%，n=21），而IA组为7.4%（n=2），但这种差异无统计学意义（p=0.24）。
我们发现接受IA的患者住院时间缩短。IA组术后肠梗阻发生率也有临床显著降低，但无统计学意义。然而，两组其他测量的短期结局相似。
