Brunner Maximilian, Bondartschuk Katja, Denz Axel, Weber Georg F, Grützmann Robert, Krautz Christian
Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, 91054, Erlangen, Germany.
Langenbecks Arch Surg. 2025 Jun 9;410(1):180. doi: 10.1007/s00423-025-03749-x.
Minimally invasive right hemicolectomy can be performed with either an extracorporeal or intracorporeal anastomosis, with the latter gaining increasing popularity. This study aimed to evaluate the impact of the anastomotic technique on postoperative outcomes and recovery.
We retrospectively reviewed 177 patients who underwent minimally invasive right hemicolectomy with complete mesocolic excision (CME) at our institution from 2016 to May 2024. Of these, 96 patients received an extracorporeal hand-sewn end-to-end anastomosis, while 81 patients underwent an intracorporeal stapled side-to-side isoperistaltic anastomosis. The impact of the anastomotic technique on postoperative outcomes and recovery was assessed using uni- and multivariate analyses.
Patients with intracorporeal anastomoses experienced significantly fewer surgical site infections (0% vs. 3%, p = 0.032), less postoperative pain at rest and under stress on postoperative day (POD) 4 (p = 0.028 and p = 0.007, respectively), earlier first bowel movement (POD 2 vs. POD 3, p = 0.014) and shorter postoperative hospital stays (5 vs. 6 days, p = 0.049). There were no significant differences between the groups in overall morbidity, reoperations or anastomotic leakage rates. Multivariate analysis indicated that the intracorporeal anastomosis technique was significantly associated with enhanced postoperative recovery (defined as first stool by POD 2, full meal tolerance by POD 4 and discharge by POD 6; OR 0.5 [0.2-0.9], p = 0.036).
Intracorporeal stapled side-to-side anastomosis may enhance postoperative recovery after minimal-invasive right hemicolectomy with CME.
微创右半结肠切除术可采用体外或体内吻合术进行，后者越来越受欢迎。本研究旨在评估吻合技术对术后结果和恢复的影响。
我们回顾性分析了2016年至2024年5月在我院接受微创右半结肠切除术并完整结肠系膜切除（CME）的177例患者。其中，96例患者接受体外手工缝合端端吻合术，81例患者接受体内吻合器侧侧顺蠕动吻合术。采用单因素和多因素分析评估吻合技术对术后结果和恢复的影响。
体内吻合患者的手术部位感染明显较少（0%对3%，p = 0.032），术后第4天静息和应激状态下的疼痛较轻（分别为p = 0.028和p = 0.007），首次排便时间更早（术后第2天对第3天，p = 0.014），术后住院时间更短（5天对6天，p = 0.049）。两组在总体发病率、再次手术或吻合口漏率方面无显著差异。多因素分析表明，体内吻合技术与术后恢复增强显著相关（定义为术后第2天排大便、术后第4天能耐受全量饮食、术后第6天出院；OR 0.5[0.2 - 0.9]，p = 0.036）。
对于行CME的微创右半结肠切除术，体内吻合器侧侧吻合术可能会促进术后恢复。
