Comparison of Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic-assisted Hemicolectomy

Background: Laparoscopic-assisted colon resection has been shown to result in earlier return of bowel function, decreased postoperative pain, decreased length of stay, and decreased morbidity when compared to open resection. Laparoscopic-assisted hemicolectomy often still involves externalization of the bowel for resection and anastomosis. The aim of this study was to determine short-term outcomes of performing intra- versus extracorporeal resection and anastomosis in laparoscopic-assisted hemicolectomy.

Methods: Retrospective chart review of 105 consecutive patients who underwent laparoscopic-assisted hemicolectomy or colectomy by a single surgeon from January 2006 through August 2008 was performed. Pearson chi(2) and Student's t test were used to test for significance.

Results: There were 105 patients in total who underwent laparoscopic-assisted ileocolic resection (66), right hemicolectomy (29), left hemicolectomy (9), and subtotal colectomy (1). There were more males in the extracorporeal group, but patients in the two groups were otherwise demographically comparable. An intracorporeal anastomosis was performed in 54 patients and extracorporeal in 51 patients. The operation was longer in the intracorporeal group (p <or= 0.001), but estimated blood loss was less (p = 0.014). Postoperatively, there was no significant difference in time to bowel movement between the intra- and extracorporeal anastomosis groups; however, there was earlier return of flatus (2 vs. 2.4 days, respectively; p = 0.017). Postoperative narcotic use (16 vs. 49 mg morphine equivalents; p = 0.001), length of stay (3.2 vs. 3.8 days; p = 0.012), and perioperative morbidity (6 vs. 15 patients; p = 0.019) were all decreased in the intra- versus extracorporeal group, respectively. There was no perioperative mortality.

Conclusion: In comparison to the extracorporeal technique, resection and creation of the anastomosis intracorporeally produces superior results with earlier return of bowel function, decreased postoperative narcotic use, and decreased length of stay and morbidity. Further studies will be needed to verify our findings.