M Milone1, U Elmore2, M E Allaix3, P P Bianchi4, A Biondi5, L Boni6, U Bracale7, E Cassinotti6, G Ceccarelli8, F Corcione9, D Cuccurullo9, M Degiuli10, Nicolò De Manzini11, D D'Ugo5, G Formisano4, M Manigrasso7, M Morino3, S Palmisano11, R Persiani5, R Reddavid10, F Rondelli8, N Velotti7, R Rosati2, Giovanni Domenico De Palma7. 1. Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via Pansini 5, 80131, Naple, Italy. milone.marco.md@gmail.com. 2. Department of Surgery, San Raffaele Scientific Institute, University Vita Salute, Milan, Italy. 3. Department of Surgical Sciences, University of Turin, Turin, Italy. 4. Department of General and Minimally-Invasive Surgery, Misericordia Hospital, Grosseto, Italy. 5. Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Largo F. Vito, Rome, Italy. 6. Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico Hospital, University of Milan, Milan, Italy. 7. Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via Pansini 5, 80131, Naple, Italy. 8. Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy. 9. Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy. 10. Department of Oncology, Surgical Oncology and Digestive Surgery, San Luigi University Hospital (S.L.U.H.), Orbassano, Turin, Italy. 11. Operative Unit of General Surgery, University of Trieste, Trieste, Italy.
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.
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.
Entities:
Keywords:
Enterotomy closure; Laparoscopic colectomy; Right colon cancer
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