Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning, People's Republic of China.
China Medical University, Shenyang, 110122, Liaoning, People's Republic of China.
Sci Rep. 2024 Jun 10;14(1):13247. doi: 10.1038/s41598-024-63966-0.
The primary objective of this study was to compare short-term outcomes between Intracorporeal ileocolic anastomosis (IIA) and extracorporeal ileocolic anastomosis (EIA) after laparoscopic right hemicolectomy in patients with visceral obesity. The secondary objective was to identify risk factors associated with prolonged postoperative ileus (PPOI) after laparoscopic right hemicolectomy. This single-center retrospective study analyzed visceral obesity patients who underwent laparoscopic right hemicolectomy for primary bowel cancer between January 2020 and June 2023. Patients were categorized into IIA and EIA groups based on the type of anastomosis, and a 1:1 propensity score-matched analysis was performed. A total of 129 patients were initially included in this study, with 45 patients in each group following propensity score matching. The IIA group had significantly longer anastomosis times (p < 0.001), shorter incision length (p < 0.001), and shorter length of stay (p = 0.003) than the EIA group. Meanwhile, the IIA group showed a shorter time to first flatus (p = 0.044) and quicker tolerance of a solid diet (p = 0.030). On multivariate analysis, postoperative use of opioid analgesics is an independent risk factor for PPOI (OR: 3.590 95% CI 1.033-12.477, p = 0.044), while IIA is an independent protective factor (OR: 0.195 95% CI 0.045-0.843, p = 0.029). IIA remains a safe and feasible option for visceral obesity patients. It is also associated with a quicker recovery of bowel function and shorter length of stay when compared to EIA. Additionally, IIA is an independent protective factor for PPOI.
本研究的主要目的是比较内脏肥胖患者腹腔镜右半结肠切除术后行腔内回肠结肠吻合术（IIA）与腔外回肠结肠吻合术（EIA）的短期结局。次要目的是确定腹腔镜右半结肠切除术后发生术后肠麻痹（PPOI）的相关危险因素。本单中心回顾性研究分析了 2020 年 1 月至 2023 年 6 月期间因原发性肠道癌行腹腔镜右半结肠切除术的内脏肥胖患者。根据吻合术类型将患者分为 IIA 组和 EIA 组，并进行了 1:1 倾向评分匹配分析。本研究共纳入 129 例患者，匹配后每组 45 例。IIA 组吻合时间明显较长（p<0.001），切口长度明显较短（p<0.001），住院时间明显较短（p=0.003）。而 IIA 组首次排气时间较短（p=0.044），固体饮食耐受时间较快（p=0.030）。多因素分析显示，术后使用阿片类镇痛药是 PPOI 的独立危险因素（OR：3.590 95%CI 1.033-12.477，p=0.044），而 IIA 是独立保护因素（OR：0.195 95%CI 0.045-0.843，p=0.029）。对于内脏肥胖患者，IIA 仍然是一种安全可行的选择。与 EIA 相比，它还可以更快地恢复肠道功能，缩短住院时间。此外，IIA 是 PPOI 的独立保护因素。
