Intracorporeal Versus Extracorporeal Anastomosis in Patients Undergoing Laparoscopic Right Hemicolectomy: A Multicenter Randomized Clinical Trial (The IVEA-study).

OBJECTIVE: The aim of this study was to evaluate short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy for right colon neoplasm. BACKGROUND: Despite advances in the laparoscopic approach in colorectal surgery and the clear benefit of this approach over open surgery, because of the technical difficulty in performing intracorporeal anastomosis (IA), some continue to perform it extracorporeally in right colon surgery. MATERIALS AND METHODS: This study was a prospective multicenter randomized trial with 2 parallel groups on which either IA or extracorporeal anastomosis was performed in laparoscopic right hemicolectomy for right colon neoplasm, carried out between January 2016 and December 2018. RESULTS: A total of 168 patients were randomized during the study period. At baseline, the 2 groups were comparable for age, sex, body mass index, surgical risk, and comorbidity. The median length of postoperative hospital stay was 7 days with no differences between the groups. About 70% of patients had an uneventful postoperative period without complications. The most common complications were paralytic ileus (20.63%; 33), surgical site infection (SSI) (10%; 16), and anastomotic leakage (6.25%; 10). The results show a lower level of SSI in the IA group (3.65% vs. 16.67%, P=0.008). Other complications do not show statistically significant differences between groups. Likewise, the incision for the extraction of the specimen was smaller in the IA group (P=0.000) and creation of the anastomosis intracorporeally decreased postoperative pain (P=0.000). CONCLUSIONS: In comparison to the extracorporeal technique, IA decreased postoperative pain, incision size, and SSI. Further studies will be needed to verify our findings.

Uso de la sutura barbada para el cierre de la enterocolotomía tras hemicolectomía derecha con anastomosis intracorpórea. Estudio prospectivo descriptivo / Use of barbed suture for the closure of enterocolotomy after laparoscopic right hemicolectomy with intracorporeal anastomosis. A prospective descriptive study

INTRODUCCIÓN: Posiblemente la parte técnica que más destreza precisa en laparoscopia es la realización de anastomosis y suturas intracorpóreas. La aparición de las nuevas suturas barbadas durante los últimos años parece facilitar dichos gestos quirúrgicos. El objetivo de nuestro estudio es evaluar los resultados a corto plazo en pacientes con neoplasias de colon derecho, tras hemicolectomía derecha laparoscópica con anastomosis intracorpórea mediante la utilización de sutura barbada en el cierre de la enterocolotomía. MÉTODOS: Se trata de un estudio descriptivo prospectivo multicéntrico en el que se incluyen pacientes que han sido intervenidos mediante hemicolectomía derecha laparoscópica por patología neoplásica colónica entre junio del 2015 y diciembre del 2018. En todos ellos se realizó la anastomosis intracorpórea mediante el uso de endocortadora y el cierre de la enterocolotomía mediante una doble capa de sutura barbada. RESULTADOS: Se ha intervenido a un total de 80 pacientes (47,5% mujeres), con una edad media de 70,6 ± 9 (49-92) años. El tiempo operatorio medio fue 99,5 ± 38 min. Un 2,5% de la muestra presentó dehiscencia de anastomosis y se tuvo que reintervenir a 5 pacientes (6,2%) como consecuencia de 2 dehiscencias, 2 cuadros obstructivos y un sangrado peritoneal. La mediana de estancia hospitalaria fue de 7 (3-173) días. CONCLUSIONES: El uso de la sutura barbada en la hemicolectomía derecha laparoscópica con anastomosis intracorpórea parece presentar una morbilidad similar a las series descritas en la literatura. En cualquier caso, serían necesarios estudios con mayor número de pacientes, prospectivos, controlados y aleatorizados para confirmar estos hallazgos

INTRODUCTION: Performing intracorporeal anastomoses and sutures is possibly the technique that requires the greatest skill in laparoscopic surgery. The appearance of the new barbed sutures in recent years has seemed to facilitate this surgical step. The aim of our study is to evaluate short-term results in patients with neoplasms of the right colon, after laparoscopic right hemicolectomy with intracorporeal anastomosis using barbed suture at the closure of the enterocolotomy. METHODS: This is a multicenter, prospective, descriptive study that includes patients who underwent laparoscopic right hemicolectomy for neoplastic colonic pathologies between June 2015 and December 2018. In all patients, the intracorporeal anastomosis was performed using the endocutter, and closure of the enterocolotomy was done with a double layer of barbed suture. RESULTS: A total of 80 patients were treated (47.5% women), with an average age of 70.6 ± 9 (49-92) years. The average operative time was 99.5 ± 38 minutes Anastomotic dehiscence was observed in 2.5% of the sample, and 5 patients required re-operation (6.2%) as a result of 2 leaks, 2 obstructive symptoms and one peritoneal bleeding. Mean hospital stay was 7 (3-173) days. CONCLUSIONS: The use of barbed suture in laparoscopic right hemicolectomy with intracorporeal anastomosis seems to present a morbidity similar to series described in literature. Prospective, controlled and randomized studies with a larger number of patients would be necessary to confirm these findings

Use of barbed suture for the closure of enterocolotomy after laparoscopic right hemicolectomy with intracorporeal anastomosis. A prospective descriptive study. / Uso de la sutura barbada para el cierre de la enterocolotomía tras hemicolectomía derecha con anastomosis intracorpórea. Estudio prospectivo descriptivo.

INTRODUCTION: Performing intracorporeal anastomoses and sutures is possibly the technique that requires the greatest skill in laparoscopic surgery. The appearance of the new barbed sutures in recent years has seemed to facilitate this surgical step. The aim of our study is to evaluate short-term results in patients with neoplasms of the right colon, after laparoscopic right hemicolectomy with intracorporeal anastomosis using barbed suture at the closure of the enterocolotomy. METHODS: This is a multicenter, prospective, descriptive study that includes patients who underwent laparoscopic right hemicolectomy for neoplastic colonic pathologies between June 2015 and December 2018. In all patients, the intracorporeal anastomosis was performed using the endocutter, and closure of the enterocolotomy was done with a double layer of barbed suture. RESULTS: A total of 80 patients were treated (47.5% women), with an average age of 70.6±9 (49-92) years. The average operative time was 99.5±38minutes Anastomotic dehiscence was observed in 2.5% of the sample, and 5 patients required re-operation (6.2%) as a result of 2leaks, 2obstructive symptoms and one peritoneal bleeding. Mean hospital stay was 7 (3-173) days. CONCLUSIONS: The use of barbed suture in laparoscopic right hemicolectomy with intracorporeal anastomosis seems to present a morbidity similar to series described in literature. Prospective, controlled and randomized studies with a larger number of patients would be necessary to confirm these findings.