Intracorporeal Versus Extracorporeal Ileocolic Anastomosis in Laparoscopic Right Hemicolectomy: Leakage Rate

Document Type : Mini Review


1 Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy

2 Department of General Surgery, Carlo Urbani Hospital, Jesi (Ancona), Italy


Context: Colorectal carcinoma is among the common cancers that affect people in western countries, and the incidence was approximated at 1.36 million cases globally in 2012. A right hemicolectomy is a routine procedure for right-sided colonic cancer. Currently, laparoscopic-assisted right hemicolectomy is typically performed using the extracorporeal anastomotic method. However, despite the inception of laparoscopic surgery and advanced recovery techniques for colorectal surgery, morbidity rates remain considerable. Evidence Acquisition: The literature was systematically analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. In-depth research was conducted using Embase and PubMed’s bibliographic data sources with the help of a medical librarian. Studies that were eligible were randomized controlled trials, human research, or comparative studies on intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy
Results: A total of 2694 studies were initially obtained. From them, 14 non-randomized comparative academic works were eligible for inclusion in the assessment, with a total of 1494 patients. We found that intracorporeal anastomosis in laparoscopic right hemicolectomy is associated with minimized short-range morbidity as well as a shorter hospital stay. However, we identified an absence of a remarkable difference for anastomotic leakage between the intra- and the extra-corporeal techniques.
Conclusions: Our systematic evaluation indicates no notable difference in the rate of discharge between intracorporeal anastomosis and extracorporeal anastomosis in laparoscopic right hemicolectomy. However, randomized controlled trials are required to confirm the discovery made by this study.


1.            Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International journal of cancer. 2015;136(5):E359-E86.
2.            Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh J-WW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. European journal of cancer. 2013;49(6):1374-403.
3.            Van Leersum N, Snijders H, Henneman D, Kolfschoten N, Gooiker G, Ten Berge M, et al. The Dutch surgical colorectal audit. European Journal of Surgical Oncology (EJSO). 2013;39(10):1063-70.
4.            Schwenk W, Haase O, Neudecker JJ, Müller JM. Short term benefits for laparoscopic colorectal resection. Cochrane database of systematic reviews. 2005(2).
5.            Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Annals of surgery. 2011;254(6):868-75.
6.            Bergamaschi R, Schochet E, Haughn C, Burke M, Reed JF, Arnaud J-P. Standardized laparoscopic intracorporeal right colectomy for cancer: short-term outcome in 111 unselected patients. Diseases of the colon & rectum. 2008;51(9):1350-5.
7.            Barnett RB, Clement GS, Drizin GS, Josselson AS, Prince DS. Pulmonary changes after laparoscopic cholecystectomy. Surgical laparoscopy & endoscopy. 1992;2(2):125-7.
8.            Hellan M, Anderson C, Pigazzi A. Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2009;13(3):312.
9.            Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine. 2009;6(7):e1000097.
10.          Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument. ANZ journal of surgery. 2003;73(9):712-6.
11.          van Oostendorp S, Elfrink A, Borstlap W, Schoonmade L, Sietses C, Meijerink J, et al. Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surgical endoscopy. 2017;31(1):64-77.
12.          Bland JM, Altman DG. The odds ratio. Bmj. 2000;320(7247):1468.
13.          Hambleton RK, Rogers HJ. Detecting potentially biased test items: Comparison of IRT area and Mantel-Haenszel methods. Applied Measurement in Education. 1989;2(4):313-34.
14.          McHugh ML. The chi-square test of independence. Biochemia medica. 2013;23(2):143-9.
15.          Chang K, Fakhoury M, Barnajian M, Tarta C, Bergamaschi R. Laparoscopic right colon resection with intracorporeal anastomosis. Surgical endoscopy. 2013;27(5):1730-6.
16.          Kayaalp C, Yagci MA. Laparoscopic right colon resection with transvaginal extraction: a systematic review of 90 cases. Surgical laparoscopy, endoscopy & percutaneous techniques. 2015;25(5):384-91.
17.          Wolthuis AM, van Overstraeten AdB, D’Hoore A. Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World Journal of Gastroenterology: WJG. 2014;20(36):12981.