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

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.

Keywords: Anastomosis; Extracorporeal; Intracorporeal; Laparoscopic; Recovery; Right colectomy; Right hemicolectomy.