Intracorporeal vs. extracorporeal anastomosis preference for minimally invasive right hemicolectomy: A combined SAGES and EAES survey

Introduction: Intracorporeal anastomosis (ICA) for minimally invasive (MIS) right hemicolectomy is associated with lower rates of postoperative ileus, pain, and future ventral incisional hernia when compared to extracorporeal anastomosis (ECA). However, the rate of adoption of ICA has been slow. This may be attributed to the advanced minimally invasive intracorporeal suturing technical skills required for ICA. A survey was distributed among SAGES and EAES members to assess the current level of adoption of ICA into clinical practice. Methods: An anonymous 13 question survey was distributed to SAGES and EAES members in 2023–2024 via email, SAGES Facebook, and SAGES Twitter/X. Response inclusion criteria included performing at least 20 minimally invasive segmental colectomies annually. Questions included year of surgical training completion, ICA vs. ECA preference with rationale, and ICA type of training and/or mentorship. A Chi-square test was used to compare the association between decade of training completion and use of ICA vs ECA. Results: 902 respondents participated and 796 performed at least 20 minimally invasive segmental colectomies per year. 457 (57%) were currently performing ICA for right hemicolectomies in over 80% of cases. Of these 457 respondents, over half reported several benefits when performing ICA vs ECA including less subjective pain (281, 64%) and lower rate of surgical site infections (274, 63%). When asked about the biggest hurdle to performing ICA, the 339 (43%) ECA preferred respondents selected added time and/or cost in the OR. There was no statistically significant association between the decade of training and choice of surgical technique (p = 0.829). Discussion: Adoption of ICA for minimally invasive right hemicolectomy is on the rise in this predominantly advanced MIS group of surgeons, as it is routinely performed by over half of the SAGES and EAES membership. Operative time, cost, and additional training and mentorship are the barriers for wider adoption.