A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy
Purpose 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. Methods A systematic review was carried out to ide...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2017-05, Vol.402 (3), p.417-427 |
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| creator | Ricci, Claudio Casadei, Riccardo Alagna, Vincenzo Zani, Elia Taffurelli, Giovanni Pacilio, Carlo Alberto Minni, Francesco |
| description | Purpose
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.
Methods
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.
Results
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
|
| doi_str_mv | 10.1007/s00423-016-1509-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1835503087</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1835503087</sourcerecordid><originalsourceid>FETCH-LOGICAL-c344t-bfcc3a4127a75e58b9576686ce16795e11f0135f2886b71d49b302212eb23f5c3</originalsourceid><addsrcrecordid>eNp9kctOHDEQRa0oEa_wAdlEXrJp8LMfS4QgiYTEBtaW21PNGHW3Oy43zHwRvxk3M7BgkZVL9rm3XHUJ-cHZOWesukDGlJAF42XBNWuKzRdyxJXUhVCaf_2olTwkx4hPjLGyatQBORSVbrSumyPyekld9Mk721M7rqgLwxRhDSP6Z6C4xQSDzc80wrOHlzdmgGQLO9p-ix5p6CimeeUB38Q2-vGR-jFF60KcQoS9M2w-XVlMYQiLhR9pb7MyoAvT0ss_rhNdw-Bd6MFlbPudfOtsj3C6P0_Iw831_dXv4vbu15-ry9vCSaVS0XbOSau4qGylQddto6uyrEsHPI-ugfOOcak7UddlW_GValrJhOACWiE77eQJOdv5TjH8nQGTGTw66Hs7QpjR8FpqzSSrq4zyHeryxzFCZ6boBxu3hjOz5GN2-Zicj1nyMZus-bm3n9sBVh-K90AyIHYATssiIZqnMMe8a_yP6z-L9aC3</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1835503087</pqid></control><display><type>article</type><title>A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Ricci, Claudio ; Casadei, Riccardo ; Alagna, Vincenzo ; Zani, Elia ; Taffurelli, Giovanni ; Pacilio, Carlo Alberto ; Minni, Francesco</creator><creatorcontrib>Ricci, Claudio ; Casadei, Riccardo ; Alagna, Vincenzo ; Zani, Elia ; Taffurelli, Giovanni ; Pacilio, Carlo Alberto ; Minni, Francesco</creatorcontrib><description>Purpose
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.
Methods
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.
Results
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.
Conclusions
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.</description><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-016-1509-x</identifier><identifier>PMID: 27595589</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Anastomosis, Surgical - adverse effects ; Anastomosis, Surgical - methods ; Cardiac Surgery ; Colectomy - adverse effects ; Colectomy - methods ; Colon - surgery ; General Surgery ; Humans ; Ileum - surgery ; Laparoscopy - adverse effects ; Laparoscopy - methods ; Medicine ; Medicine & Public Health ; Postoperative Complications - epidemiology ; Systematic Reviews and Meta-analyses ; Thoracic Surgery ; Traumatic Surgery ; Vascular Surgery</subject><ispartof>Langenbeck's archives of surgery, 2017-05, Vol.402 (3), p.417-427</ispartof><rights>Springer-Verlag Berlin Heidelberg 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c344t-bfcc3a4127a75e58b9576686ce16795e11f0135f2886b71d49b302212eb23f5c3</citedby><cites>FETCH-LOGICAL-c344t-bfcc3a4127a75e58b9576686ce16795e11f0135f2886b71d49b302212eb23f5c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-016-1509-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-016-1509-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27595589$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ricci, Claudio</creatorcontrib><creatorcontrib>Casadei, Riccardo</creatorcontrib><creatorcontrib>Alagna, Vincenzo</creatorcontrib><creatorcontrib>Zani, Elia</creatorcontrib><creatorcontrib>Taffurelli, Giovanni</creatorcontrib><creatorcontrib>Pacilio, Carlo Alberto</creatorcontrib><creatorcontrib>Minni, Francesco</creatorcontrib><title>A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>Purpose
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.
Methods
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.
Results
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.
Conclusions
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.</description><subject>Abdominal Surgery</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Anastomosis, Surgical - methods</subject><subject>Cardiac Surgery</subject><subject>Colectomy - adverse effects</subject><subject>Colectomy - methods</subject><subject>Colon - surgery</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Ileum - surgery</subject><subject>Laparoscopy - adverse effects</subject><subject>Laparoscopy - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Postoperative Complications - epidemiology</subject><subject>Systematic Reviews and Meta-analyses</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Vascular Surgery</subject><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctOHDEQRa0oEa_wAdlEXrJp8LMfS4QgiYTEBtaW21PNGHW3Oy43zHwRvxk3M7BgkZVL9rm3XHUJ-cHZOWesukDGlJAF42XBNWuKzRdyxJXUhVCaf_2olTwkx4hPjLGyatQBORSVbrSumyPyekld9Mk721M7rqgLwxRhDSP6Z6C4xQSDzc80wrOHlzdmgGQLO9p-ix5p6CimeeUB38Q2-vGR-jFF60KcQoS9M2w-XVlMYQiLhR9pb7MyoAvT0ss_rhNdw-Bd6MFlbPudfOtsj3C6P0_Iw831_dXv4vbu15-ry9vCSaVS0XbOSau4qGylQddto6uyrEsHPI-ugfOOcak7UddlW_GValrJhOACWiE77eQJOdv5TjH8nQGTGTw66Hs7QpjR8FpqzSSrq4zyHeryxzFCZ6boBxu3hjOz5GN2-Zicj1nyMZus-bm3n9sBVh-K90AyIHYATssiIZqnMMe8a_yP6z-L9aC3</recordid><startdate>20170501</startdate><enddate>20170501</enddate><creator>Ricci, Claudio</creator><creator>Casadei, Riccardo</creator><creator>Alagna, Vincenzo</creator><creator>Zani, Elia</creator><creator>Taffurelli, Giovanni</creator><creator>Pacilio, Carlo Alberto</creator><creator>Minni, Francesco</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170501</creationdate><title>A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy</title><author>Ricci, Claudio ; Casadei, Riccardo ; Alagna, Vincenzo ; Zani, Elia ; Taffurelli, Giovanni ; Pacilio, Carlo Alberto ; Minni, Francesco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c344t-bfcc3a4127a75e58b9576686ce16795e11f0135f2886b71d49b302212eb23f5c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdominal Surgery</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Anastomosis, Surgical - methods</topic><topic>Cardiac Surgery</topic><topic>Colectomy - adverse effects</topic><topic>Colectomy - methods</topic><topic>Colon - surgery</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Ileum - surgery</topic><topic>Laparoscopy - adverse effects</topic><topic>Laparoscopy - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Postoperative Complications - epidemiology</topic><topic>Systematic Reviews and Meta-analyses</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ricci, Claudio</creatorcontrib><creatorcontrib>Casadei, Riccardo</creatorcontrib><creatorcontrib>Alagna, Vincenzo</creatorcontrib><creatorcontrib>Zani, Elia</creatorcontrib><creatorcontrib>Taffurelli, Giovanni</creatorcontrib><creatorcontrib>Pacilio, Carlo Alberto</creatorcontrib><creatorcontrib>Minni, Francesco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ricci, Claudio</au><au>Casadei, Riccardo</au><au>Alagna, Vincenzo</au><au>Zani, Elia</au><au>Taffurelli, Giovanni</au><au>Pacilio, Carlo Alberto</au><au>Minni, Francesco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2017-05-01</date><risdate>2017</risdate><volume>402</volume><issue>3</issue><spage>417</spage><epage>427</epage><pages>417-427</pages><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>Purpose
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.
Methods
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.
Results
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.
Conclusions
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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>27595589</pmid><doi>10.1007/s00423-016-1509-x</doi><tpages>11</tpages></addata></record> |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Anastomosis, Surgical - adverse effects Anastomosis, Surgical - methods Cardiac Surgery Colectomy - adverse effects Colectomy - methods Colon - surgery General Surgery Humans Ileum - surgery Laparoscopy - adverse effects Laparoscopy - methods Medicine Medicine & Public Health Postoperative Complications - epidemiology Systematic Reviews and Meta-analyses Thoracic Surgery Traumatic Surgery Vascular Surgery |
| title | A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy |
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