A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy

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Abstract
Two main techniques are commonly used during laparoscopic right hemicolectomy in order to perform the ileocolic anastomosis: intracorporeal (IA) and extracorporeal (EA). The aim of this study was to evaluate the safety of the two techniques. A systematic review was carried out to identify studies comparing IA and EA. The primary endpoint was anastomotic leakage. The secondary endpoints were intra- and postoperative results. A meta-analysis was carried out using the random-effects model. Fourteen studies matched the selection criteria, enrolling 1717 patients (50.3 % IA, 49.7 % EA). The anastomotic leakage was similar in the IA and the EA groups (3.4 vs. 4.6 %, respectively) with a risk difference (RD) of −0.01 (95 % CI = −0.03 to 0.01; P = 0.120). IA group had lower overall complication rate (27.6 vs. 38.4 %; RD = −0.15; 95 % CI = 0.27 to −0.04; P = 0.009) and wound infection rate (4.9 vs. 8.9 %; RD = 0.52; −0.03; 95 % CI = −0.06 to −0.01; P = 0.030). Time to first oral intake (weighted mean difference (WMD) = −1; 95 % CI = −1.59 to −0.41; P < 0.001), length of hospital stay (WMD = −1.13; 95 % CI = −1.90 to −0.35; P = 0.004) and minilaparotomy size (WMD = −26; 95 % CI = −38 to −13; P < 0.001) were shorter in IA patients. The incisional hernia rate was lower in the IA group (2.3 vs. 13.7 %) with an RD of −0.09 (95 % CI = −0.17 to −0.02; P = 0.020). There were no differences in operative time, blood loss, conversion, internal hernia, reoperation, mortality, time to first flatus and defecation, analgesic required, number of lymph nodes harvested and length of distal margin. Laparoscopic right hemicolectomy with IA is a safe alternative to EA. Additional well-structured, prospective randomised trials are needed to confirm all the advantages regarding postoperative results which were pointed out in our study.

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