A systematic review and meta-analysis comparing intracorporeal anastomosis and extracorporeal anastomosis in minimally invasive colectomies

Sean S. W. Park, Daniel Feng, Stephen Smith
2020 Mini-invasive Surgery  
How to cite this article: Park SSW, Feng D, Smith S. A systematic review and meta-analysis comparing intracorporeal anastomosis and extracorporeal anastomosis in minimally invasive colectomies. Abstract Aim: This systemic review aims to determine if intracorporeal anastomosis (IA) adds value to patient outcomes without compromising operative and oncological safety when compared to extracorporeal anastomosis (EA) in laparoscopic colectomies. This is the first systematic review with meta-analysis
more » ... to evaluate the outcomes in a combined fashion including both laparoscopic right and left colectomies. Methods: A systematic review of Medline, EMBASE, Cochrane Library, and PubMed was performed on studies analysing direct comparison between IA and EA. The primary outcome was anastomotic leakage. Quality assessment was carried out using a modified Institute of Health Economics appraisal tool. Meta-analysis was performed using a random-effects model. Results: A total of 24 papers with 2,674 patients were included in the analysis. No significant difference was found in anastomotic leakage (OR = 0.84; 95%CI: 0.54-1.31; P = 0.44) and short-term mortality (OR = 0.56; 95%CI: 0.20-1.58; P = 0.27) between the IA and EA cohorts. The IA cohort was associated with faster return of bowel function [MD = -0.53 days; 95%CI: -0.67-(-0.39); P < 0.00001] and lower incidence of surgical site infection (OR = 0.52; 95%CI: 0.31-0.85; P = 0.009). The number of lymph nodes harvested was higher in IA (MD = 1.05; 95%CI: 0.19-1.91; P = 0.02; I 2 = 83%) with considerable heterogeneity. Conclusion: Intracorporeal anastomosis can be considered a safe alternative technique in laparoscopic colectomies, with potential benefits in patient outcomes. A lack of randomised studies and heterogeneity need to be addressed by additional high-quality trials.
doi:10.20517/2574-1225.2020.87 fatcat:ootxcvojqzgofn6niupfn6ny6e