Short-term Outcomes of Intracorporeal Versus Extracorporeal Totally Stapled Anastomosis After Laparoscopic Colectomy: A Propensity Score-matched Cohort Study

Overview

Journal J Anus Rectum Colon

Date 2025 Jan 30

PMID 39882225

Authors

Yoshiaki Fujii

Kenji Kobayashi

Hirozumi Sawai

Seiya Yamamoto

Shuhei Uehara

Hirotaka Miyai

Hiroki Takahashi

Shuji Takiguchi

Affiliations

Soon will be listed here.

Abstract

Objectives: 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).

Methods: 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.

Results: 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).

Conclusions: 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.

References

Li J, Ge Y, Yang Y, Zhang J . Comparison of delta-shaped anastomosis and Billroth I reconstruction after laparoscopic distal gastrectomy for gastric cancer. J Gastrointest Oncol. 2021; 12(2):259-267. PMC: 8107602. DOI: 10.21037/jgo-21-109. View

Hamamoto H, Okuda J, Izuhara K, Ishii M, Osumi W, Masubuchi S . Closure of enterotomy after side-to-side ileocolic anastomosis with two barbed sutures in totally laparoscopic colectomy for right-sided colon cancer. Surg Today. 2020; 51(3):457-461. PMC: 7892497. DOI: 10.1007/s00595-020-02108-1. View

Tajima J, Nagayama S, Hiyoshi Y, Mukai T, Nagasaki T, Yamaguchi T . Colonic delta-shaped anastomosis using linear staplers in laparoscopic colectomy. Tech Coloproctol. 2020; 25(4):473-474. PMC: 8016753. DOI: 10.1007/s10151-020-02341-3. View

Bollo J, Turrado V, Rabal A, Carrillo E, Gich I, Martinez M . Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial). Br J Surg. 2019; 107(4):364-372. DOI: 10.1002/bjs.11389. View

Jamali F, Soweid A, Dimassi H, Bailey C, Leroy J, Marescaux J . Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg. 2008; 143(8):762-7. DOI: 10.1001/archsurg.143.8.762. View

Harada J, Kinoshita T, Sato R, Akimoto E, Yoshida M, Nishiguchi Y . Delta-shaped gastroduodenostomy after totally laparoscopic distal gastrectomy for gastric cancer: comparative study of original and modified methods. Surg Endosc. 2020; 35(8):4167-4174. DOI: 10.1007/s00464-020-07896-8. View

Fujii Y, Kobayashi K, Yamamoto S, Kimura S, Miyai H, Hayakawa T . Delta-shaped overlap anastomosis in laparoscopic colectomy with mechanical closure of the enterotomy. Tech Coloproctol. 2021; 25(8):971-972. DOI: 10.1007/s10151-021-02443-6. View

Milone M, Elmore U, Vignali A, Gennarelli N, Manigrasso M, Burati M . Recovery after intracorporeal anastomosis in laparoscopic right hemicolectomy: a systematic review and meta-analysis. Langenbecks Arch Surg. 2017; 403(1):1-10. DOI: 10.1007/s00423-017-1645-y. View

Feroci F, Lenzi E, Garzi A, Vannucchi A, Cantafio S, Scatizzi M . Intracorporeal versus extracorporeal anastomosis after laparoscopic right hemicolectomy for cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2013; 28(9):1177-86. DOI: 10.1007/s00384-013-1651-7. View

10.

Emile S, Elfeki H, Shalaby M, Sakr A, Bassuni M, Christensen P . Intracorporeal versus extracorporeal anastomosis in minimally invasive right colectomy: an updated systematic review and meta-analysis. Tech Coloproctol. 2019; 23(11):1023-1035. DOI: 10.1007/s10151-019-02079-7. View

11.

Carnuccio P, Jimeno J, Pares D . Laparoscopic right colectomy: a systematic review and meta-analysis of observational studies comparing two types of anastomosis. Tech Coloproctol. 2013; 18(1):5-12. DOI: 10.1007/s10151-013-1029-4. View

12.

Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J . Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev. 2008; 34(6):498-504. DOI: 10.1016/j.ctrv.2008.03.011. View

13.

Wei D, Johnston S, Goldstein L, Nagle D . Minimally invasive colectomy is associated with reduced risk of anastomotic leak and other major perioperative complications and reduced hospital resource utilization as compared with open surgery: a retrospective population-based study of.... Surg Endosc. 2019; 34(2):610-621. DOI: 10.1007/s00464-019-06805-y. View

14.

Nelson H, Sargent D, Wieand H, Fleshman J, Anvari M, Stryker S . A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004; 350(20):2050-9. DOI: 10.1056/NEJMoa032651. View

15.

Watanabe J, Ishibe A, Takei S, Suwa Y, Suwa H, Endo I . A new intracorporeal suture-less stapled end-to-end anastomosis in laparoscopic left-colectomy for colon cancer - a video vignette. Colorectal Dis. 2020; 22(11):1803-1804. DOI: 10.1111/codi.15232. View

16.

Mari G, Crippa J, Costanzi A, Pellegrino R, Siracusa C, Berardi V . Intracorporeal Anastomosis Reduces Surgical Stress Response in Laparoscopic Right Hemicolectomy: A Prospective Randomized Trial. Surg Laparosc Endosc Percutan Tech. 2018; 28(2):77-81. DOI: 10.1097/SLE.0000000000000506. View

17.

Allaix M, Degiuli M, Bonino M, Arezzo A, Mistrangelo M, Passera R . Intracorporeal or Extracorporeal Ileocolic Anastomosis After Laparoscopic Right Colectomy: A Double-blinded Randomized Controlled Trial. Ann Surg. 2019; 270(5):762-767. DOI: 10.1097/SLA.0000000000003519. View

18.

Buunen M, Veldkamp R, Hop W, Kuhry E, Jeekel J, Haglind E . Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2008; 10(1):44-52. DOI: 10.1016/S1470-2045(08)70310-3. View

19.

Wu Q, Jin C, Hu T, Wei M, Wang Z . Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Right Colectomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A. 2016; 27(4):348-357. DOI: 10.1089/lap.2016.0485. View

20.

Jarry C, Carcamo L, Gonzalez J, Bellolio F, Miguieles R, Urrejola G . Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay. Updates Surg. 2020; 73(1):93-100. DOI: 10.1007/s13304-020-00840-4. View