Intracorporeal or Extracorporeal Ileocolic Anastomosis After Laparoscopic Right Colectomy: A Double-blinded Randomized Controlled Trial

Objectives: The aim of the study was to determine whether there are clinically relevant differences in outcomes between laparoscopic right colectomy (LRC) with intracorporeal ileocolic anastomosis (IIA) and LRC with extracorporeal IA (EIA). Background: IIA and EIA are 2 well-established techniques for restoration of bowel continuity after LRC. There are no high-quality studies demonstrating the superiority of one anastomotic technique over the other. Methods: This is a double-blinded randomized controlled trial comparing the outcomes of LRC with IIA and LRC with EIA in patients with a benign or malignant right-sided colon neoplasm. Primary endpoint was length of hospital stay (LOS). This trial was registered with ClinicalTrials.gov, number NCT03045107. Results: A total of 140 patients were randomized and analyzed. Median operative time was comparable in IIA versus EIA group {130 [interquartile range (IQR) 105–195] vs 130 (IQR 110–180) min; P ¼ 0.770} and no intraoperative complications occurred. The quicker recovery of bowel function after IIA than EIA [gas: 2 (IQR 2–3) vs 3 (IQR 2–3) days, P ¼ 0.003; stool: 4 (IQR 3–5) vs 4.5 (IQR 3–5) days, P ¼ 0.032] was not reflected in any advantage in the primary endpoint: median LOS was similar in the 2 groups [6 (IQR 5–7) vs 6 (IQR 5–8) days; P ¼ 0.839]. No significant differences were observed in the number of lymph nodes harvested, length of skin incision, 30- day morbidity (17.1% vs 15.7%, P ¼ 0.823), reoperation rate, and readmission rate between the 2 groups. Conclusions: LRC with IIA is associated with earlier recovery of postoperative bowel function than LRC with EIA; however, it does not reflect into a shorter LOS. Keywords: anastomosis, extracorporeal, intracorporeal, laparoscopic right colectomy, randomized controlled trial