Short-term outcomes of intracorporeal versus extracorporeal ileotransverse anastomosis in laparoscopic right colectomy: A prospective randomized study

Abstract

Background: Laparoscopic right colectomy is a widely accepted surgical technique for colon cancer resection, commonly using either intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA). Our study compares the benefits of ICA versus ECA, as ICA has been suggested to provide faster recovery and shorter hospital stays. However, there is a lack of scientific evidence in this regard. Patients and Methods: An randomized clinical trial was conducted from November 2021 to June 2023 to compare intraoperative technical events and short-term postoperative clinical outcomes. Results: A total of 71 were randomized. The median operative time for the ECA group was 226.67 min (range: 167–310) and 222.78 min for the ICA group (range: 158–263) with no significant difference between them ( P=0.606 ). There is no significant difference in the number of harvested lymph nodes between the ECA group (mean: 13.88, range: 12–15) and the ICA group (mean: 13.78, range: 12–16) ( P=0.664 ). The incidence of postoperative ileus, vomiting, and intestinal obstruction did not differ significantly between the two groups ( P=0.728 , 0.795, and 0.885, respectively). Significantly, there was a higher incidence of wound infection in the ECA group ( P=0.047 ). The ICA group had significantly lower pain scale scores on the postoperative day ( P<0.001 ). Significantly shorter mean length of postoperative hospital stays was seen in the ICA group (4.15 vs. 5.27 for ECA, P<0.001 ). Delayed postoperative complications showed no significant difference ( P=0.061 and 0.362 for incisional hernia and internal hernia, respectively). Conclusion: ICA has less postoperative pain, shorter time to first flatus, shorter length of hospital stays, and lower rates of wound infection with nearly the same operative time compared with ECA.