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01-02-2020 | Colectomy

Fashioning enterotomy closure after totally laparoscopic ileocolic anastomosis for right colon cancer: a multicenter experience

Authors: M. Milone, U. Elmore, M. E. Allaix, P. P. Bianchi, A. Biondi, L. Boni, U. Bracale, E. Cassinotti, G. Ceccarelli, F. Corcione, D. Cuccurullo, M. Degiuli, Nicolò De Manzini, D. D’Ugo, G. Formisano, M. Manigrasso, M. Morino, S. Palmisano, R. Persiani, R. Reddavid, F. Rondelli, N. Velotti, R. Rosati, Giovanni Domenico De Palma

Published in: Surgical Endoscopy | Issue 2/2020

Abstract

Background

Laparoscopic right hemicolectomy is a commonly performed procedure. Little is known on how to perform the enterotomy closure after stapled side-to-side intracorporeal anastomosis.

Method

A multicentric case-controlled study has been designed to compare different ways to fashion enterotomy closure: double layer versus single layer, sewn versus stapled, and robotic versus laparoscopic approach. Furthermore, additional characteristics including sutures’ materials, interrupted versus running suture and the presence of deep corner suture has been investigated.

Results

We collected data for 1092 patients who underwent right hemicolectomy at ten centers. We analyzed 176 robotic against 916 laparoscopic anastomosis: no significant differences were found in terms of bleedings (p = 0.455) and anastomotic leak (p = 0.405). We collected data from 126 laparoscopic sewn single-layer versus 641 laparoscopic sewn double-layer anastomosis: a significant reduction was recorded in terms of leaks in double-layer group (p = 0.02). About double-layer characteristics, we found a significant reduction of bleedings (p = 0.008) and leaks (p = 0.017) with a running suture; similarly, a reduction of bleedings (p = 0.001) and leaks (p = 0.005) was observed with the usage of deep corner closure. The presence of a barbed suture thread seemed to significantly reduce both bleedings (p = 0.001) and leaks (p = 0.001). We found no significant differences in terms of bleedings (p = 0.245) and anastomotic leak (p = 0.660) comparing sewn versus stapled anastomosis.

Conclusions

Fashioning a stapled ileocolic intracorporeal anastomosis, we can recommend the adoption of a double-layer enterotomy closure using a running barbed suture in the first layer. Totally, stapled closure and robotic assistance have to be considered a non-inferior alternative.

van Oostendorp S, Elfrink A, Borstlap W, Schoonmade L, Sietses C, Meijerink J, Tuynman J (2017) Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc 31(1):64–77CrossRef

Milone M, Elmore U, Di Salvo E, Delrio P, Bucci L, Ferulano GP, Napolitano C, Angiolini MR, Bracale U, Clemente M, D’ambra M, Luglio G, Musella M, Pace U, Rosati R, Milone F (2015) Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc 29(8):2314–2320CrossRef

Milone M, Angelini P, Berardi G, Burati M, Corcione F, Delrio P, Elmore U, Lemma M, Manigrasso M, Mellano A, Muratore A, Pace U, Rega D, Rosati R, Tartaglia E, De Palma GD (2018) Intracorporeal versus extracorporeal anastomosis after laparoscopic left colectomy for splenic flexure cancer: results from a multi-institutional audit on 181 consecutive patients. Surg Endosc 32(8):3467–3473CrossRef

Wu Q, Jin C, Hu T, Wei M, Wang Z (2017) Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 27(4):348–357CrossRef

Shapiro R, Keler U, Segev L, Sarna S, Hatib K, Hazzan D (2016) Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis. Surg Endosc 30(9):3823–3829CrossRef

Vignali A, Bissolati M, De Nardi P, Di Palo S, Staudacher C (2016) Extracorporeal vs intracorporeal ileocolic stapled anastomoses in laparoscopic right colectomy: an interim analysis of a randomized clinical trial. J Laparoendosc Adv Surg Tech A 26(5):343–348CrossRef

Ricci C, Casadei R, Alagna V, Zani E, Taffurelli G, Pacilio CA, Minni F (2017) A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy. Langenbecks Arch Surg 402(3):417–427CrossRef

Vignali A, Elmore U, Lemma M, Guarnieri G, Radaelli G, Rosati R (2018) Intracorporeal versus extracorporeal anastomoses following laparoscopic right colectomy in obese patients: a case-matched study. Dig Surg. 35(3):236–242CrossRef

Hanna MH, Hwang GS, Phelan MJ, Bui TL, Carmichael JC, Mills SD, Stamos MJ, Pigazzi A (2016) Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis. Surg Endosc 30(9):3933–3942CrossRef

10.

Bracale U, Merola G, Cabras F, Andreuccetti J, Corcione F, Pignata G (2018) The use of barbed suture for intracorporeal mechanical anastomosis during a totally laparoscopic right colectomy: is it safe? A retrospective nonrandomized comparative multicenter study. Surg Innov 25(3):267–273CrossRef

11.

Feroci F, Giani I, Baraghini M, Romoli L, Zalla T, Quattromani R, Cantafio S, Scatizzi M (2018) Barbed versus traditional suture for enterotomy closure after laparoscopic right colectomy with intracorporeal mechanical anastomosis: a case–control study. Updates Surg 70(4):433–439CrossRef

12.

Reggio S, Sciuto A, Cuccurullo D, Pirozzi F, Esposito F, Cusano D, Corcione F (2015) Single-layer versus double-layer closure of the enterotomy in laparoscopic right hemicolectomy with intracorporeal anastomosis: a single-center study. Tech Coloproctol 19(12):745–750CrossRef

13.

Rausa E, Kelly ME, Asti E, Aiolfi A, Bonitta G, Bonavina L (2018) Right hemicolectomy: a network meta-analysis comparing open, laparoscopic-assisted, total laparoscopic, and robotic approach. Surg Endosc. https://doi.org/10.1007/s00464-018-6592-3 CrossRefPubMed

14.

Milone M, Elmore U, Vignali A, Gennarelli N, Manigrasso M, Burati M, Milone F, De Palma GD, Delrio P, Rosati R (2018) Recovery after intracorporeal anastomosis in laparoscopic right hemicolectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 403(1):1–10CrossRef

15.

Carnuccio P, Jimeno J, Parés D (2014) Laparoscopic right colectomy: a systematic review and meta-analysis of observational studies comparing two types of anastomosis. Tech Coloproctol 18(1):5–12CrossRef

16.

Kornmann VN, Hagendoorn J, van Koeverden S, van Ramshorst B, Smits AB (2013) Totally laparoscopic right hemicolectomy with intracorporeal anastomosis is a technically and oncologically safe procedure. Acta Chir Belg 113(6):439–443CrossRef

17.

Biondi A, Santocchi P, Pennestrì F, Santullo F, D’Ugo D, Persiani R (2017) Totally laparoscopic right colectomy versus laparoscopically assisted right colectomy: a propensity score analysis. Surg Endosc 31(12):5275–5282CrossRef

18.

Marchesi F, Pinna F, Percalli L, Cecchini S, Riccó M, Costi R, Pattonieri V, Roncoroni L (2013) Totally laparoscopic right colectomy: theoretical and practical advantages over the laparo-assisted approach. J Laparoendosc Adv Surg Tech A 23(5):418–424CrossRef

19.

Magistro C, Lernia SD, Ferrari G, Zullino A, Mazzola M, De Martini P, De Carli S, Forgione A, Bertoglio CL, Pugliese R (2013) Totally laparoscopic versus laparoscopic-assisted right colectomy for colon cancer: is there any advantage in short-term outcomes? A prospective comparative assessment in our center. Surg Endosc 27(7):2613–2618CrossRef

20.

Neutzling CB, Lustosa SA, Proenca IM, da Silva EM, Matos D (2012) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 15(2):CD003144

21.

Lustosa SA, Matos D, Atallah AN, Castro AA (2002) Stapled versus handsewn methods for colorectal anastomosis surgery: a systematic review of randomized controlled trials. Sao Paulo Med J 120(5):132–136CrossRef

22.

Slieker JC, Daams F, Mulder IM, Jeekel J, Lange JF (2013) Systematic review of the technique of colorectal anastomosis. JAMA Surg 148(2):190–201CrossRef

23.

Scotton G, Contardo T, Zerbinati A, Tosato SM, Orsini C, Morpurgo E (2018) From laparoscopic right colectomy with extracorporeal anastomosis to robot-assisted intracorporeal anastomosis to totally robotic right colectomy for cancer: the evolution of robotic multiquadrant abdominal surgery. J Laparoendosc Adv Surg Tech A 28(10):1216–1222CrossRef

24.

Ibáñez N, Abrisqueta J, Luján J, Hernández Q, Rufete MD, Parrilla P (2018) Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI). Surg Endosc. https://doi.org/10.1007/s00464-018-6580-7 CrossRefPubMed

25.

Bergamaschi R, Arnaud JP, Mårvik R, Myrvold HE (2002) Laparoscopic antiperistaltic versus isoperistaltic gastrojejunostomy for palliation of gastric outlet obstruction in advanced cancer. Surg Laparosc Endosc Percutan Tech 12(6):393–397CrossRef

26.

Roy S, Ghosh S, Yoo A (2015) An assessment of the clinical and economic impact of establishing ileocolic anastomoses in right-colon resection surgeries using mechanical staplers compared to hand-sewn technique. Surg Res Pract 2015:749186PubMedPubMedCentral

27.

Formisano G, Misitano P, Giuliani G, Calamati G, Salvischiani L, Bianchi PP (2016) Laparoscopic versus robotic right colectomy: technique and outcomes. Updates Surg 68(1):63–69CrossRef

28.

Trastulli S, Coratti A, Guarino S, Piagnerelli R, Annecchiarico M, Coratti F, Di Marino M, Ricci F, Desiderio J, Cirocchi R, Parisi A (2015) Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study. Surg Endosc 29(6):1512–1521CrossRef

29.

Morpurgo E, Contardo T, Molaro R, Zerbinati A, Orsini C, D’Annibale A (2013) Robotic-assisted intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right hemicolectomy for cancer: a case control study. J Laparoendosc Adv Surg Tech A 23(5):414–417CrossRef

30.

Trastulli S, Desiderio J, Farinacci F, Ricci F, Listorti C, Cirocchi R, Boselli C, Noya G, Parisi A (2013) Robotic right colectomy for cancer with intracorporeal anastomosis: short-term outcomes from a single institution. Int J Colorectal Dis 28(6):807–814CrossRef

31.

Milone M, Di Minno MN, Galloro G, Maietta P, Bianco P, Milone F, Musella M (2013) Safety and efficacy of barbed suture for gastrointestinal suture: a prospective and randomized study on obese patients undergoing gastric bypass. J Laparoendosc Adv Surg Tech A 23(9):756–759CrossRef

32.

Demyttenaere SV, Nau P, Henn M, Beck C, Zaruby J, Primavera M, Kirsch D, Miller J, Liu JJ, Bellizzi A, Melvin WS (2009) Barbed suture for gastrointestinal closure: a randomized control trial. Surg Innov 16(3):237–242CrossRef

33.

Omotosho P, Yurcisin B, Ceppa E, Miller J, Kirsch D, Portenier DD (2011) In vivo assessment of an absorbable and nonabsorbable knotless barbed suture for laparoscopic single-layer enterotomy closure: a clinical and biomechanical comparison against nonbarbed suture. J Laparoendosc Adv Surg Tech A 21(10):893–897CrossRef

Title: Fashioning enterotomy closure after totally laparoscopic ileocolic anastomosis for right colon cancer: a multicenter experience
Authors: M. Milone
U. Elmore
M. E. Allaix
P. P. Bianchi
A. Biondi
L. Boni
U. Bracale
E. Cassinotti
G. Ceccarelli
F. Corcione
D. Cuccurullo
M. Degiuli
Nicolò De Manzini
D. D’Ugo
G. Formisano
M. Manigrasso
M. Morino
S. Palmisano
R. Persiani
R. Reddavid
F. Rondelli
N. Velotti
R. Rosati
Giovanni Domenico De Palma
Publication date: 01-02-2020
Publisher: Springer US
Keywords: Colectomy
Colectomy
Hemicolectomy
Hemicolectomy
Colon Cancer
Colon Cancer
Published in: Surgical Endoscopy / Issue 2/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06796-w

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Springer Medicine

Fashioning enterotomy closure after totally laparoscopic ileocolic anastomosis for right colon cancer: a multicenter experience

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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