Laparoscopic right colectomies with intracorporeal compared to extracorporeal anastomotic techniques are associated with reduced post-operative incisional hernias.

Autor: Selznick S; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Science Centre, 339 Windermere Rd, London, ON, N6A 5A5, Canada., Levy J; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Science Centre, 339 Windermere Rd, London, ON, N6A 5A5, Canada., Bogdan RM; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Science Centre, 339 Windermere Rd, London, ON, N6A 5A5, Canada., Hawel J; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Science Centre, 339 Windermere Rd, London, ON, N6A 5A5, Canada., Elnahas A; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Science Centre, 339 Windermere Rd, London, ON, N6A 5A5, Canada., Alkhamesi NA; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Science Centre, 339 Windermere Rd, London, ON, N6A 5A5, Canada., Schlachta CM; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Science Centre, 339 Windermere Rd, London, ON, N6A 5A5, Canada. Christopher.Schlachta@lhsc.on.ca.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Jul; Vol. 37 (7), pp. 5500-5508. Date of Electronic Publication: 2022 Oct 03.
DOI: 10.1007/s00464-022-09585-0
Abstrakt: Background: Owing to important differences in surgical technique, laparoscopic right colectomy with intracorporeal (ICA) compared to extracorporeal (ECA) anastomotic technique may result in improved patient outcomes. We aimed to compare both techniques according to incisional hernias and other pertinent perioperative characteristics, post-operative complications, and oncologic quality markers.
Methods: All adult patients undergoing laparoscopic right colectomies between 2015 and 2020 at a single institution were included. ICA and ECA techniques were compared based on selected outcomes using univariable and multivariable statistical analyses, as appropriate. Subgroup analyses were restricted to patients with neoplastic indications for surgery and non-urgent operations.
Results: A total of 517 patients met inclusion criteria, of which 139 (26.9%) underwent ICA and 378 (73.1%) underwent ECA. ICA and ECA patients had similar baseline characteristics. At two years of follow-up, a lower proportion of ICA patients developed a hernia at the extraction incision (1.5% vs. 7.1%, p = 0.02) and ICA was associated with an 80% reduction in extraction incision hernias (aHR 0.20, p = 0.03). These results were stable through subgroup and sensitivity analyses. Median operative time was longer in the ICA group (186 min vs. 135 min, p < 0.001), but the gap in operative time narrowed during the study period. Median length of stay was one calendar day shorter in the ICA group (3 days vs. 4 days, p = 0.007) and ICA was associated with a 13% decrease in the length of stay (aRR 0.87, p = 0.02). The incidence of superficial wound infections, anastomotic leaks and re-interventions was lower in ICA patients, but this difference was not statistically significant. 90-day unscheduled visits, readmissions, and mortalities were similar across both groups, as were oncologic outcomes.
Conclusion: Laparoscopic right colectomies with intracorporeal anastomoses are associated with a reduction in incisional hernias and shorter hospital lengths of stay without compromising on patient safety or oncologic principles.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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