Intracorporeal vs extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy

Abstract

Introduction: Anastomotic leak after ileocolic anastomosis influences morbidity and mortality of a patient. Therefore, protection of ileocolic anastomosis is of paramount importance in laparoscopic right hemicolectomy.

Methods: A retrospective study of seventy-nine patients who belong to American Society of Anaesthesiologists physical status classification class 1 and 2 who had undergone laparoscopic right hemicolectomy due to caecal or ascending colonic pathologies were selected for the study. A comparison between the two groups of patients who had undergone intracorporeal vs extracorporeal ileocolic anastomosis was done with regards to occurrence of anaestomotic leaks, paralytic ileus, duration of hospital stay and duration taken to tolerate a soft tissue.

All patients were managed in high dependency units with optimum facilities under fast-track category. Every patient was under patient-controlled analgesia for pain control.

Results: Of the 79 patients studied, 40 had intracorporeal anastomosis (ICA) whereas 39 had extracorporeal anastomosis (ECA). Age range of the patients was 40 - 75 years. Out of the 40 patients who had ICA, only one patient developed anastomotic leak and out of those who had ECA, 3 patients had anastomotic leaks (p=0.36). Two out of 3 patients who had anaestomotic leaks following the ECA, underwent lower midline laparotomies to rectify the leak. Four (4/40, 40%) patients in ICA group and 6 (6/39, 60%) patients in the ECA group had developed post op paralytic ileus (p=0.52). Average durations of hospital stay were 4 and 5 respectively for ICA and ECA groups and both groups were able to tolerate a soft diet on post operative day 2.

Conclusions: ICA has improved the outcome of ileocolic anastomosis in the studied group of patients compare to ECA, although the observed differences between the two groups were not statistically significant.