Intracorporeal stapled versus extracorporeal hand-sewn anastomosis in minimal-invasive right hemicolectomy with complete mesocolic excision – a retrospective single center analysis

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BACKGROUND: Minimally invasive right hemicolectomy can be performed with either an extracorporeal or intracorporeal anastomosis, with the latter gaining increasing popularity. This study aimed to evaluate the impact of the anastomotic technique on postoperative outcomes and recovery. METHODS: We retrospectively reviewed 177 patients who underwent minimally invasive right hemicolectomy with complete mesocolic excision (CME) at our institution from 2016 to May 2024. Of these, 96 patients received an extracorporeal hand-sewn end-to-end anastomosis, while 81 patients underwent an intracorporeal stapled side-to-side isoperistaltic anastomosis. The impact of the anastomotic technique on postoperative outcomes and recovery was assessed using uni- and multivariate analyses. RESULTS: Patients with intracorporeal anastomoses experienced significantly fewer surgical site infections (0% vs. 3%, p = 0.032), less postoperative pain at rest and under stress on postoperative day (POD) 4 (p = 0.028 and p = 0.007, respectively), earlier first bowel movement (POD 2 vs. POD 3, p = 0.014) and shorter postoperative hospital stays (5 vs. 6 days, p = 0.049). There were no significant differences between the groups in overall morbidity, reoperations or anastomotic leakage rates. Multivariate analysis indicated that the intracorporeal anastomosis technique was significantly associated with enhanced postoperative recovery (defined as first stool by POD 2, full meal tolerance by POD 4 and discharge by POD 6; OR 0.5 [0.2-0.9], p = 0.036). CONCLUSION: Intracorporeal stapled side-to-side anastomosis may enhance postoperative recovery after minimal-invasive right hemicolectomy with CME.

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