Our Summary

This research paper is a thorough analysis of previous studies comparing two approaches to a surgical procedure called a laparoscopic right colectomy. This is a minimally invasive surgery to remove the right part of the colon. The two approaches in question are extracorporeal anastomosis (EA), where the surgeon connects the remaining parts of the colon outside the patient’s body, and intracorporeal anastomosis (IA), where the connection is made inside the body.

The analysis looked at 24 studies involving almost 3700 patients between 2004 and 2020. The main measure of success was whether or not the patient developed a type of infection called a parietal abscess after surgery. The study also considered other factors such as how long it took for patients to pass gas and stool after surgery, how long they stayed in the hospital, and whether they needed further surgery to fix hernias.

The results showed that the IA approach was associated with fewer parietal abscesses and shorter hospital stays. Patients who had the IA procedure also passed gas and stool earlier, indicating a quicker recovery, and were less likely to need further surgery. The overall complication rates were similar for both methods.

The authors conclude that the IA approach seems to offer some advantages over the EA approach for patients undergoing a laparoscopic right colectomy.

FAQs

  1. What is the difference between intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right colectomy?
  2. What were the main findings of the meta-analysis comparing IA and EA during laparoscopic right colectomy?
  3. How does intracorporeal anastomosis affect the rate of parietal abscesses and other postoperative outcomes in laparoscopic right colectomy?

Doctor’s Tip

A doctor may tell a patient undergoing laparoscopic colectomy that studies have shown that intracorporeal anastomosis (IA) during the procedure may lead to a decrease in parietal abscesses and faster recovery times compared to extracorporeal anastomosis (EA). Discussing the option of IA with your surgeon may be beneficial for your overall outcome.

Suitable For

Patients who are typically recommended for laparoscopic colectomy include those with conditions such as colon cancer, diverticulitis, inflammatory bowel disease, and other benign or malignant colon conditions that require surgical removal of a portion of the colon. These patients may benefit from the minimally invasive approach of laparoscopic colectomy, which can result in faster recovery times, reduced pain, and shorter hospital stays compared to traditional open surgery.

Timeline

Before laparoscopic colectomy:

  • Patient undergoes preoperative evaluation and consultation with surgeon
  • Patient may need to undergo preoperative testing such as blood work, imaging studies, and colonoscopy
  • Patient is instructed on preoperative preparation such as bowel cleansing and dietary restrictions
  • Patient is admitted to the hospital on the day of surgery

After laparoscopic colectomy:

  • Patient undergoes the laparoscopic colectomy procedure
  • Patient is monitored in the recovery room before being transferred to a hospital room
  • Patient may have a nasogastric tube, urinary catheter, and IV lines in place initially
  • Patient is encouraged to start walking and resume a normal diet as tolerated
  • Patient may experience pain, bloating, and fatigue in the days following surgery
  • Patient is discharged from the hospital once they are able to tolerate food and pain is controlled
  • Patient follows up with surgeon for postoperative care and monitoring of recovery progress.

What to Ask Your Doctor

  1. What are the potential benefits of intracorporeal anastomosis (IA) compared to extracorporeal anastomosis (EA) in laparoscopic colectomy?
  2. What are the potential risks or complications associated with IA versus EA in laparoscopic colectomy?
  3. How does the time to onset of gas and stools differ between IA and EA in laparoscopic colectomy?
  4. How does the length of hospital stay typically compare between patients undergoing IA versus EA in laparoscopic colectomy?
  5. Are there any specific factors that may make a patient a better candidate for IA versus EA in laparoscopic colectomy?
  6. What is the expected recovery time and postoperative care for patients undergoing IA versus EA in laparoscopic colectomy?
  7. How many lymph nodes are typically removed during IA versus EA in laparoscopic colectomy?
  8. What is the rate of postoperative incisional hernias in patients undergoing IA versus EA in laparoscopic colectomy?
  9. Are there any long-term considerations or outcomes that should be discussed when deciding between IA and EA in laparoscopic colectomy?
  10. What is your experience and expertise with performing IA versus EA in laparoscopic colectomy procedures?

Reference

Authors: Selvy M, Mattevi C, Slim K, Pezet D, Pereira B, Le Roy B. Journal: Int J Colorectal Dis. 2020 Sep;35(9):1673-1680. doi: 10.1007/s00384-020-03675-y. Epub 2020 Jul 21. PMID: 32691134