De Giulio Ernesto, Turri Giulia, Sciortino Ruben, Rivelli Matteo, Gecchele Gabriele, Valdegamberi Alessandro, Campagnaro Tommaso, Ruzzenente Andrea, Pedrazzani Corrado
Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, University of Verona, Verona, Italy.
Division of General and Hepatobiliary Surgery, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy.
Int J Colorectal Dis. 2025 May 8;40(1):112. doi: 10.1007/s00384-025-04903-z.
The anastomosis technique following laparoscopic right colectomy remains a subject of ongoing debate. One of the potential advantages of intracorporeal anastomosis is the flexibility it offers in selecting the location of the minilaparotomy. This study aimed to evaluate the differences in the rate of incisional hernia between intracorporeal and extracorporeal anastomosis after laparoscopic right colectomy.
We retrospectively analysed patients undergoing laparoscopic right colectomy for colon neoplasia between April 2013 and January 2024, retrieved from a prospectively maintained database. The occurrence of incisional hernia was assessed according to the anastomosis technique. Univariate and multivariate analyses were performed to investigate the relationship between incisional hernia and anastomosis technique, while controlling for other risk factors.
Among 192 patients, 94 underwent intracorporeal anastomosis and 98 underwent extracorporeal anastomosis. The groups were comparable in terms of clinical, pathological, and surgical data. The intracorporeal group showed a lower incidence, although not statistically significant, of postoperative ileus (p = 0.052), and a shorter hospital stay (p = 0.003). No incisional hernias were observed at the minilaparotomy site in the intracorporeal anastomosis group, while 13.3% of patients in the extracorporeal anastomosis group developed an incisional hernia (p < 0.001). One incisional hernia at the umbilical trocar site occurred after intracorporeal anastomosis. Multivariate analysis identified postoperative general complications (OR [95% CI]: 4.1 [1.0-16.5], p = 0.049) and extracorporeal anastomosis (OR [95% CI]: 15.4 [1.0-126.9], p = 0.011) as independent risk factors for incisional hernia.
Intracorporeal anastomosis significantly reduces the incidence of incisional hernia at the minilaparotomy site. This finding is further supported by logistic regression analysis, which identified intracorporeal anastomosis as a significant and independent protective factor against incisional hernia.
腹腔镜右半结肠切除术后的吻合技术仍是一个持续争论的话题。体内吻合的潜在优势之一是在选择小切口剖腹术位置时具有灵活性。本研究旨在评估腹腔镜右半结肠切除术后体内吻合与体外吻合之间切口疝发生率的差异。
我们回顾性分析了2013年4月至2024年1月期间因结肠肿瘤接受腹腔镜右半结肠切除术的患者，数据来自前瞻性维护的数据库。根据吻合技术评估切口疝的发生情况。在控制其他危险因素的同时，进行单因素和多因素分析以研究切口疝与吻合技术之间的关系。
192例患者中，94例行体内吻合，98例行体外吻合。两组在临床、病理和手术数据方面具有可比性。体内吻合组术后肠梗阻发生率较低（p = 0.052），虽无统计学意义，且住院时间较短（p = 0.003）。体内吻合组在小切口剖腹术部位未观察到切口疝，而体外吻合组13.3%的患者发生了切口疝（p < 0.001）。体内吻合术后在脐部套管针部位发生了1例切口疝。多因素分析确定术后全身并发症（OR [95% CI]：4.1 [1.0 - 16.5]，p = 0.049）和体外吻合（OR [95% CI]：15.4 [1.0 - 126.9]，p = 0.011）是切口疝的独立危险因素。
体内吻合显著降低了小切口剖腹术部位的切口疝发生率。逻辑回归分析进一步支持了这一发现，该分析确定体内吻合是预防切口疝的重要且独立的保护因素。
