Fujii Yoshiaki, Kobayashi Kenji, Sawai Hirozumi, Yamamoto Seiya, Uehara Shuhei, Miyai Hirotaka, Takahashi Hiroki, Takiguchi Shuji
Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Surgery, Kariya Toyota General Hospital, Kariya, Japan.
J Anus Rectum Colon. 2025 Jan 25;9(1):95-104. doi: 10.23922/jarc.2024-010. eCollection 2025.
To describe detailed surgical techniques for totally stapled intracorporeal anastomosis (TSIA) and determine their feasibility and safety by comparing short-term outcomes with those of conventional totally stapled extracorporeal anastomosis (TSEA).
In total, 59 consecutive patients who underwent laparoscopic colectomy between June 2018 and August 2021 were retrospectively assessed. Linear staplers were used for all anastomoses. The TSIA and TSEA groups included 23 and 36 patients, respectively. Following a comprehensive description of each surgical technique, propensity score matching analysis was conducted to compare matched groups on the basis of clinicopathological characteristics, surgical and perioperative outcomes, complications, and postoperative inflammatory reactions. After matching, 17 cases each were analyzed in the TSIA and TSEA groups.
Both groups were well matched. The TSIA group had significantly lesser blood loss than did the TSEA group (10 versus 20 mL, p=0.002), although this result was not clinically significant. The skin excision length (4 versus 6 cm, p<0.001) and postoperative hospital stay length (6 versus 7 days, p<0.001) were significantly shorter in the TSIA group than in the TSEA group. Increasing C-reactive protein (CRP) values at 1, 3, and 6 postoperative days were significantly lower in the TSIA group than in the TSEA group (p=0.016, p=0.011, and p=0.012, respectively).
TSIA is a simple, feasible, and efficient surgical technique; compared with TSEA, it is less invasive and associated with lesser blood loss, shorter skin incision lengths, shorter postoperative hospital stays, and lower CRP level increases.
描述完全吻合器体内吻合术（TSIA）的详细手术技术，并通过比较其与传统完全吻合器体外吻合术（TSEA）的短期结果来确定其可行性和安全性。
回顾性评估2018年6月至2021年8月期间连续接受腹腔镜结肠切除术的59例患者。所有吻合均使用直线吻合器。TSIA组和TSEA组分别包括23例和36例患者。在全面描述每种手术技术后，进行倾向评分匹配分析，以根据临床病理特征、手术和围手术期结果、并发症及术后炎症反应对匹配组进行比较。匹配后，TSIA组和TSEA组各分析17例。
两组匹配良好。TSIA组的失血量明显少于TSEA组（10 ml对20 ml，p = 0.002），尽管这一结果在临床上无显著意义。TSIA组的皮肤切口长度（4 cm对6 cm，p < 0.001）和术后住院时间（6天对7天，p < 0.001）明显短于TSEA组。术后第1、3和6天TSIA组的C反应蛋白（CRP）值升高明显低于TSEA组（分别为p = 0.016、p = 0.011和p = 0.012）。
TSIA是一种简单、可行且有效的手术技术；与TSEA相比，其创伤较小，失血量较少，皮肤切口长度较短，术后住院时间较短，CRP水平升高较低。
