Delta-shaped overlap anastomosis in laparoscopic colectomy with mechanical closure of the enterotomy

Excerpt

Currently, it is well documented that laparoscopic colectomy (LC) has short-term advantages over open colectomy but similar long-term oncological outcomes for malignant disease. In conventional LC, bowel mobilization and vessel ligation are performed laparoscopically, whereas resection of the specimen and anastomosis are performed extracorporeally. Several systematic reviews and meta-analyses based on observational data have compared the perioperative outcomes of intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right colectomy [1, 2]. These studies demonstrated the short-term postoperative advantages of IA with regard to early recovery of gastrointestinal function, decreased length of hospital stay, lower morbidity rates, and better cosmesis, among others. IA has not yet been performed in many centers around the world because it is a more demanding procedure than EA, especially in terms of enterotomy closure [3]. In Japan, IA in LC is performed by means of functional end-to-end anastomosis (FEEA), overlap anastomosis (OLA) and delta-shaped anastomosis (DSA) using linear staplers (see attached Suppl. video 1). FEEA is antiperistaltic side-to-side anastomosis. OLA is the isoperistaltic side-to-side anastomosis. DSA is the isoperistaltic end-to-end anastomosis [4]. Many gastrointestinal surgeons are familiar with FEEA and OLA. On the other hand, some surgeons are unfamiliar with DSA in LC. In DSA, the posterior walls of both intestinal tracts are anastomosed using a 45 mm linear stapler with the pre-attached bioabsorbable reinforcement material. The enterotomy was partially closed using a 30 mm linear stapler and then completely closed with a second 60 mm linear stapler. To date, there have been no studies on the optimal IA in LC. In FEEA, the anastomosis is antiperistalstic, and a larger range of bowel mobilization is required. In DSA, the anastomosis is isoperistaltic requiring smaller range of bowel mobilization, but the enterotomy is closed by linear staplers twice, and a bioabsorbable reinforcement material attached to the stapler is required. In OLA, the anastomosis is isoperistaltic, and the enterotomy is generally closed using a hand-sewn procedure. …