Intracorporeal versus extracorporeal anastomosis during laparoscopic right hemicolectomy - Systematic review and meta-analysis

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• 作者：Roberto Cirocchi^a ; ^{cirocchiroberto@yahoo.it} ; Stefano Trastulli^a ; ^{stefano.trastulli@hotmail.it} ; Eriberto Farinella^b ; ^{eriberto.far@gmail.com} ; Salvatore Guarino^c ; ^{salvatore.guarino@gmail.com} ; Jacopo Desiderio^a ; ^{djdesi85@hotmail.it} ; Carlo Boselli^d ; ^{carloboselli@yahoo.it} ; Amilcare Parisi^e ; ^{amilcareparisi@alice.it} ; Giuseppe Noya^d ; ^{noyagiuseppe@unipg.it} ; Karem Slim^f ; ^{kslim@chu-clermontferrand.fr}
• 关键词：Ileocolic anastomosis ; Right laparoscopic colectomy
• 刊名：Surgical Oncology
• 出版年：2013
• 出版时间：March, 2013
• 年：2013
• 卷：22
• 期：1
• 页码：1-13
• 全文大小：525 K

文摘

Background

Since 2005, after an initial scanty spreading, the vast majority of surgeons advice against the intracorporeal ileocolic anastomosis following right hemicolectomies. In the subsequent years, greater interest was re-discovered for the intracorporeal ileocolic anastomosis formed after video-assisted right hemicolectomies

Objective

The aim of this systematic review is to compare the intra-abdominal versus extra-abdominal anastomosis after right laparoscopic colectomy.

Data sources

A systematic search was conducted in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central and the Science Citation Index.

Study selection

A total of 191 publications were identified; seven non-randomized studies published between 2004 and 2012 with a total of 945 patients, who underwent laparoscopic right colectomy for malignant and benign disease, were included in this systematic review.

Intervention: Intra-abdominal versus extra-abdominal confectioning of ileo-coloc anastomosis after right laparoscopic colectomy.

Main outcome measures

Anastomotic leak, overall post-operative morbidity and overall 30-days post-operative mortality.

Results

Anastomotic leak rate resulted similar in IA (1.13 % ) and EA (1.84 % ) group (P = 0.81, OR of 0.90, 95 % CI 0.24-3.10) (Chi² = 3.90, P = 0.42, I² = 0 % ). The mortality rate was lower in the IA group (0.34 % ?versus 1.32 % ), although no statistically difference was demonstrated between the two groups (P?=?0.48, OR of 0.52 95 % CI 0.09-3.10). It was not possible to conduct a meta-analysis of post-operative morbidity as the data reported in the included studies were too heterogeneous.

Limitations

The weakness in our results was due to the lack of evidence in current published literature.

Conclusions

The present systematic review of literature and meta-analysis failed to solve the controversies between intracorporeal and extracorporeal anastomosis after laparoscopic right hemicolectomy. Future randomized, controlled trials are needed to further evaluate different surgical anastomosis after laparoscopic right hemicolectomy.