Intra-corporeal vs Extra-corporeal Anastomosis in Laparoscopically Assisted Right Hemicolectomy
Condition: Pain
Study type: Interventional

Summary: 
      The creation of an intracorporeal anastomosis during right hemicolectomy is regarded as
      superior than the extracorporeal anastomosis in terms of recovery of peristalsis, aesthetic
      results, analgesia requirements and length of hospital stay. The objective of this study is
      to compare the postoperative results of intracorporeal versus extracorporeal anastomosis in
      patients undergoing laparoscopic right hemicolectomy.
    

Detailed description: 
      Laparoscopic surgery has entailed a great technical revolution in colorectal surgery,
      providing a better and quicker return to normal functions of the patients, associating a
      lower morbidity and better aesthetic results compared with traditional open surgery. This
      study wants to find the difference between intracorporeal and extracorporeal anastomosis.

      The creation of an intracorporeal anastomosis in right hemicolectomy seems superior to
      extracorporeal anastomosis in terms of recovery of the normal bowel function, wound size,
      aesthetic results and analgesia requirements. This will entail a shorter hospital stay.
      Several studies have demonstrated this but all of them are retrospective non randomised.

      In terms of postoperative pain, the most accepted theory is that it depends on the traction
      of the porto-mesenteric axis. When the intracorporeal anastomosis is performed there is no
      traction of this mesenteric axis while in the extracorporeal anastomosis this traction is
      more important in obese patients.

      This traction of the mesentery, as well as being one of the main factors related with
      postoperative pain, is responsible of the postoperative adynamic ileus, that should have a
      higher incidence when the manipulation is higher.

      In the patients undergoing an intracorporeal anastomosis, the assistance incision will be a
      suprapubic Pfannenstiel. In the patients undergoing an extracorporeal anastomosis the
      assistance incision will be a transverse in the right upper quadrant. It is well known that
      the Pfannenstiel incision has a lower incidence of superficial surgical wound infection, a
      lower rate of incisional hernia, a lower need of analgesics, and better aesthetic results,
      when compared with the incision in the right upper quadrant.

      All this factors should entail a lower hospital stay in patients undergoing an intracorporeal
      anastomosis.
    

Intervention name(s): Intracorporeal anastomosis.; Extracorporeal anastomosis; Echelon Endopatch; Proximate Linear Cutter
Intervention type(s): Procedure; Procedure; Device; Device
Intervention description(s): Iso or anti-peristaltic side-to-side ileo-colonic anastomosis with Echelon Endopatch and closure of the defect with running suture or another firing of Echelon Endopatch. The surgical specimen will be retrieved through a Pfannenstiel incision.; A transverse incision in the right upper quadrant will be performed. An iso or anti-peristaltic side-to-side ileo-colonic anastomosis with Proximate Linear Cutter device and Proximate Stapler.; Use of an Echelon Endopatch Powered Device to perform an ileocolonic side-to-side anastomosis.; Use of a Proximate Linear Cutter device to perform a side-to-side ileo-colonic anastomosis.Use of a Proximate stapler to the closure of the defect associated with the creation of the side-to-side ileo-colonic anastomosis.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: intracorporeal anastomosis; laparoscopic colectomy; outcomes; length of stay; analgesia; aesthetic; extracorporeal anastomosis; laparoscopic