Intracorporeal anastomoses in minimally invasive right colectomies are associated with fewer incisional hernias and shorter length of stay Journal Article

   

Authors:	Widmar, M.; Aggarwal, P.; Keskin, M.; Strombom, P. D.; Patil, S.; Smith, J. J.; Nash, G. M.; Garcia-Aguilar, J.
Article Title:	Intracorporeal anastomoses in minimally invasive right colectomies are associated with fewer incisional hernias and shorter length of stay
Abstract:	BACKGROUND: Intracorporeal anastomosis is associated with several short-term benefits. However, it is a technically challenging procedure with potential risk OBJECTIVE: The purpose of this study was to investigate differences in short-term complications and long-term incisional hernia rates after robotic right colectomy with intracorporeal versus extracorporeal anastomoses and standardized extraction sites. DESIGN: This was a historical cohort study. SETTINGS: The study was conducted at a single institution. PATIENTS: All of the patients undergoing robotic right colectomy with intracorporeal anastomosis and a Pfannenstiel extraction site or extracorporeal anastomosis with a vertical midline extraction site from 2013 to 2017 were eligible. Exclusion criteria were conversion to laparotomy for tumor-related reasons or lack of follow-up. INTERVENTION: Intracorporeal or extracorporeal anastomosis was performed, based on availability of the robotic stapler and appropriate bedside assistance. MAIN OUTCOME MEASURES: The primary outcome was incisional hernia, diagnosed either clinically or on postoperative imaging, and analyzed using time-to-event analysis. A Cox proportional hazards model was used for multivariable analysis. Secondary outcomes were analyzed using parametric and nonparametric tests. Statistical significance was set at p < 0.05. RESULTS: Of 164 patients who met all inclusion criteria, 67 had intracorporeal and 97 had extracorporeal anastomoses. Median follow-up time was similar in both groups (14 vs 15 mo; p = 0.73). The 1-year estimated incisional hernia rate was 12% for extracorporeal and 2% for intracorporeal anastomoses (p = 0.007); this difference was confirmed by multivariable modeling. The severity of postoperative complications was similar between the groups, but there was an increase in incisional infections and a shorter length of stay (1 day) for intracorporeal cases. LIMITATIONS: The study was limited by its retrospective, single-surgeon nature. CONCLUSIONS: Right colectomy with intracorporeal anastomosis and a Pfannenstiel extraction site may reduce the rate of incisional hernias compared with extracorporeal anastomosis with a vertical midline extraction site. The intracorporeal approach was also associated with a decreased length of stay but an increase in incisional surgical site infections. These findings have implications for healthcare use and patient-centered outcomes. See Video Abstract at http://links.lww.com/DCR/B147..
Keywords:	colorectal cancer; hernia; anastomosis; outcomes; follow-up; colorectal-cancer; long-term; extracorporeal; surgical complications; clasicc trial; robotic colectomy; assisted resection; laparoscopic right hemicolectomy; intracorporeal anastomosis; personal financial burden; ileocolic
Journal Title:	Diseases of the Colon and Rectum
Volume:	63
Issue:	5
ISSN:	0012-3706
Publisher:	Lippincott Williams & Wilkins
Date Published:	2020-05-01
Start Page:	685
End Page:	692
Language:	English
ACCESSION:	WOS:000528580600017
DOI:	10.1097/dcr.0000000000001612
PROVIDER:	wos
PMCID:	PMC7148181
PUBMED:	32168093
Notes:	Article -- Source: Wos

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