Intracorporeal Anastomoses in Minimally Invasive Right Colectomies Are Associated With Fewer Incisional Hernias and Shorter Length of Stay.

BACKGROUND Intracorporeal anastomosis is associated with several short-term benefits. However, it is a technically challenging procedure with potential risk OBJECTIVE:: The purpose of this study was to investigate differences in short-term complications and long-term incisional hernia rates after robotic right colectomy with intracorporeal versus extracorporeal anastomoses and standardized extraction sites. DESIGN This was a historical cohort study. SETTINGS The study was conducted at a single institution. PATIENTS All of the patients undergoing robotic right colectomy with intracorporeal anastomosis and a Pfannenstiel extraction site or extracorporeal anastomosis with a vertical midline extraction site from 2013 to 2017 were eligible. Exclusion criteria were conversion to laparotomy for tumor-related reasons or lack of follow-up. INTERVENTION Intracorporeal or extracorporeal anastomosis was performed, based on availability of the robotic stapler and appropriate bedside assistance. MAIN OUTCOME MEASURES The primary outcome was incisional hernia, diagnosed either clinically or on postoperative imaging, and analyzed using time-to-event analysis. A Cox proportional hazards model was used for multivariable analysis. Secondary outcomes were analyzed using parametric and nonparametric tests. Statistical significance was set at p < 0.05. RESULTS Of 164 patients who met all inclusion criteria, 67 had intracorporeal and 97 had extracorporeal anastomoses. Median follow-up time was similar in both groups (14 vs 15 mo; p = 0.73). The 1-year estimated incisional hernia rate was 12% for extracorporeal and 2% for intracorporeal anastomoses (p = 0.007); this difference was confirmed by multivariable modeling. The severity of postoperative complications was similar between the groups, but there was an increase in incisional infections and a shorter length of stay (1 day) for intracorporeal cases. LIMITATIONS The study was limited by its retrospective, single-surgeon nature. CONCLUSIONS Right colectomy with intracorporeal anastomosis and a Pfannenstiel extraction site may reduce the rate of incisional hernias compared with extracorporeal anastomosis with a vertical midline extraction site. The intracorporeal approach was also associated with a decreased length of stay but an increase in incisional surgical site infections. These findings have implications for healthcare use and patient-centered outcomes. See Video Abstract at http://links.lww.com/DCR/B147. ANASTOMOSIS INTRACORPOREAS EN COLECTOMIAS DERECHAS MINIMAMENTE INVASIVAS SE ASOCIAN CON MENOS HERNIAS INCISIONALES Y UNA ESTADIA HOSPITALARIA MAS BREVE: nastomosis intracorporea se asocia con varios beneficios a corto plazo. Sin embargo, es un procedimiento tecnicamente desafiante con riesgos potenciales.nvestigar las diferencias en las complicaciones a corto plazo y las tasas de hernia incisional a largo plazo despues de la colectomia robotica derecha con anastomosis intracorporea versus extracorporea y sitios de extraccion estandarizados.Estudio de cohorte historico.cirujano individual, institucion unica.Todos los pacientes sometidos a colectomia robotica derecha con anastomosis intracorporea y un sitio de extraccion de Pfannenstiel o anastomosis extracorporea con un sitio de extraccion vertical de la linea media de 2013-2017 fueron elegibles. Los criterios de exclusion fueron la conversion a laparotomia por razones relacionadas con el tumor o la falta de seguimiento.nastomosis intracorporea o extracorporea, segun la disponibilidad de grapadora robotica y la asistencia adecuada quirurgica.El resultado primario fue la hernia incisional, diagnosticada clinicamente o en imagenes postoperatorias, y analizada mediante analisis de tiempo hasta el evento. Se uso un modelo de riesgos proporcionales de Cox para el analisis multivariable. Los resultados secundarios se analizaron mediante pruebas parametricas y no parametricas. La significacion estadistica se establecio en p < 0,05.De 164 pacientes que cumplieron con todos los criterios de inclusion, 67 tenian anastomosis intracorporeas y 97 tenian anastomosis extracorporeas. La mediana del tiempo de seguimiento fue similar en ambos grupos (14 versus 15 meses, p = 0,73). La tasa de hernia incisional estimada para un ano fue del 12% para las anastomosis extracorporeas y del 2% para las anastomosis intracorporeas (p = 0,007); esta diferencia fue confirmada por el modelado multivariable. La gravedad de las complicaciones postoperatorias fue similar entre los grupos, pero hubo un aumento de las infecciones incisionales y una estancia mas corta (un dia) para los casos intracorporeos.Retrospectiva, cirujano unico.a colectomia derecha con anastomosis intracorporea y un sitio de extraccion de Pfannenstiel puede reducir la tasa de hernias incisionales en comparacion con la anastomosis extracorporea con un sitio de extraccion vertical en la linea media. El enfoque intracorporeo tambien se asocio con una disminucion de la duracion de la estadia, pero con un aumento de las infecciones del sitio quirurgico incisional. Estos hallazgos tienen implicaciones para la utilizacion de recursos medicos y beneficios para pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B147. (Traduccion-Dr. Adrian Ortega).