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Recovery after intracorporeal anastomosis in laparoscopic right hemicolectomy: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
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Abstract

Purpose

Although intracorporeal anastomosis (IA) appears to guarantee a faster recovery compared to extracorporeal anastomosis (EA), the data are still unclear. Thus, we performed a systematic review of the literature with meta-analysis to evaluate the recovery benefits of intracorporeal anastomosis.

Materials and methods

A systematic search was performed in electronic databases (PubMed, Web of Science, Scopus, EMBASE) using the following search terms in all possible combinations: “laparoscopic,” “right hemicolectomy,” “right colectomy,” “intracorporeal,” “extracorporeal,” and “anastomosis.” According to the pre-specified protocol, all studies evaluating the impact of choice of intra- or extracorporeal anastomosis after right hemicolectomy on time to first flatus and stools, hospital stay, and postoperative complications according to Clavien-Dindo classification were included.

Results

Sixteen articles were included in the final analysis, including 1862 patients who had undergone right hemicolectomy: 950 cases (IA) and 912 controls (EA). Patients who underwent IA reported a significantly shorter time to first flatus (MD = − 0.445, p = 0.013, Z = − 2.494, 95% CI − 0.795, 0.095), to first stools (MD = − 0.684, p < 0.001, Z = − 4.597, 95% CI − 0.976, 0.392), and a shorter hospital stay (MD = − 0.782, p < 0.001, Z = −3.867, 95% CI − 1.178, − 0.385) than those who underwent EA. No statistically significant differences in complications between the IA and EA patients were observed in the Clavien-Dindo I-II group (RD = − 0.014, p = 0.797, Z = − 0.257, 95% CI − 0.117, 0.090, number needed to treat (NNT) 74) or in the Clavien-Dindo IV-V (RD = − 0.005, p = 0.361, Z = − 0.933, 95% CI − 0.017, 0.006, NNT 184). The IA procedure led to fewer complications in the Clavien-Dindo III group (RD = − 0.041, p = 0.006, Z = − 2.731, 95% CI − 0.070, 0.012, NNT 24).

Conclusions

Although intracorporeal anastomosis appears to be safe in terms of postoperative complications and is potentially more effective in terms of recovery after surgery, further ad hoc randomized clinical trials are needed, given the heterogeneity of the data available in the current literature.

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Authors and Affiliations

  1. Department of Surgical Specialties and Nephrology, University “Federico II” of Naples, Via Pansini 5, 80131, Naples, Italy

    Marco Milone, Michele Manigrasso, Morena Burati & Francesco Milone

  2. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

    Marco Milone, Ugo Elmore, Andrea Vignali, Nicola Gennarelli, Michele Manigrasso, Morena Burati, Francesco Milone, Giovanni Domenico De Palma, Paolo Delrio & Riccardo Rosati

  3. Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy

    Ugo Elmore, Andrea Vignali & Riccardo Rosati

  4. Department of Surgery and Advanced Technologies, University “Federico II” of Naples, Naples, Italy

    Nicola Gennarelli & Giovanni Domenico De Palma

  5. Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, “Fondazione Giovanni Pascale” IRCCS, Naples, Italy

    Paolo Delrio

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  1. Marco Milone
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Contributions

Milone M: conception, design, interpretation of the data, and drafting of the article; Elmore U, Vignali A, Gennarelli N, Manigrasso M, Burati M, and Milone F: acquisition, analysis, and interpretation of the data; Milone F and De Palma GD: interpretation of the data and critical revisions; Delrio P and Rosati R: critical revisions and final approval.

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Correspondence to Marco Milone.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Electronic supplementary material

Supplementary Figure 1

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Supplementary Figure F1

Funnel plots analysis. a) time to first flatus; b) time to first stools; c) hospital stay; d) Clavien I-II; e) Clavien III; f) Clavien IV-V (JPEG 205 kb)

Supplementary Table T1

Operative data (DOCX 20 kb)

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Milone, M., Elmore, U., Vignali, A. et al. Recovery after intracorporeal anastomosis in laparoscopic right hemicolectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 403, 1–10 (2018). https://doi.org/10.1007/s00423-017-1645-y

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