1
|
Nakagawa M, Kochi M, Teshima M, Kitasaki N, Abe T, Hotta R, Inoue M, Shimohana J, Toyota K. Evaluation of the short-term complications of intracorporeal anastomosis in right-sided colectomy. Asian J Endosc Surg 2024; 17:e13351. [PMID: 38978269 DOI: 10.1111/ases.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/15/2024] [Accepted: 06/23/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION The benefits of intracorporeal anastomosis in laparoscopic colorectal cancer surgery remain unclear. Therefore, we aimed to investigate the short-term postoperative outcomes of intracorporeal anastomosis. METHODS We retrospectively analyzed 87 patients who underwent laparoscopic surgery for right-sided colon tumors using a colon database. RESULTS Of the 87 patients, 23 underwent intracorporeal anastomosis and 64 underwent extracorporeal anastomosis. Intraoperative bleeding, wound length, exhaust gas, preoperative white blood cell count, and C-reactive protein (postoperative day 1) were higher in the extracorporeal anastomosis group than in the intracorporeal anastomosis group. The incidence of wound infection was higher in the intracorporeal anastomosis group than in the extracorporeal anastomosis group. In the irrigation water bacterial culture collected after anastomosis, the positive group had a higher white blood cell count on postoperative day 1 and higher C-reactive protein levels on postoperative day 3 than did the negative group. Patients who underwent chemical preparation had lower C-reactive protein levels on postoperative day 1 than did the group who did not undergo chemical preparation. CONCLUSION Despite the advantages of intracorporeal anastomosis in terms of wound length and intraoperative bleeding, the risk of infection may increase during the introduction phase. Fever and inflammatory responses are significantly elevated in culture-positive cases.
Collapse
Affiliation(s)
- Masataka Nakagawa
- Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center 513 Jike, Saijocho, Higashihiroshima, Japan
| | - Masatoshi Kochi
- Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center 513 Jike, Saijocho, Higashihiroshima, Japan
| | - Marino Teshima
- Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center 513 Jike, Saijocho, Higashihiroshima, Japan
| | - Nao Kitasaki
- Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center 513 Jike, Saijocho, Higashihiroshima, Japan
| | - Tomoyuki Abe
- Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center 513 Jike, Saijocho, Higashihiroshima, Japan
| | - Ryuichi Hotta
- Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center 513 Jike, Saijocho, Higashihiroshima, Japan
| | - Masashi Inoue
- Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center 513 Jike, Saijocho, Higashihiroshima, Japan
| | - Junichi Shimohana
- Bacteriology Laboratory, National Hospital Organization Higashihiroshima Medical Center 513 Jike, Saijocho, Higashihiroshima, Japan
| | - Kazuhiro Toyota
- Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center 513 Jike, Saijocho, Higashihiroshima, Japan
| |
Collapse
|
2
|
Perivoliotis K, Tzovaras G, Tepetes K, Baloyiannis I. Comparison of intracorporeal and extracorporeal anastomosis in laparoscopic right colectomy: an updated meta-analysis and trial sequential analysis. Updates Surg 2024; 76:375-396. [PMID: 38216794 DOI: 10.1007/s13304-023-01737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
This meta-analysis was conducted to provide updated evidence regarding perioperative safety and efficacy, of IC and EC anastomosis in laparoscopic right colectomies. In this study, the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines were applied. The study protocol received a PROSPERO registration (CRD42020214596). A systematic literature search of the electronic scholar databases (Medline, Web of Science and Scopus) was performed. To reduce type I error, a trial sequential analysis (TSA) algorithm was introduced. The quality of evidence was evaluated based on the GRADE methodology. In total, 46 studies were included in this meta-analysis, Pooled comparisons and TSA confirmed that IC is superior in terms of incisional hernia (0.29; 95%CI: 0.19, 0.44), open conversion (0.45; 95%CI: 0.30, 0.67), reoperation (0.62; 95%CI: 0.46, 0.84]), LOS (- 0.76; 95%CI: - 1.03, - 0.49), blood loss (- 11.50; 95%CI: - 18.42, - 4.58), and cosmesis (- 1.71; 95%CI: - 2.01, - 1.42). Postoperative pain and return of bowel function were, also, shortened when the anastomosis was fashioned intracorporeally. The grading of most evidence ranged from 'low' to 'high'. Due to the discrepancy in the results of RCTs and non-RCTs, and the proportionally smaller sample size of the former, further randomized trials are required to increase the evidence of this comparison.
Collapse
Affiliation(s)
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Konstantinos Tepetes
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| |
Collapse
|
3
|
Fujiwara S, Kaino K, Iseya K, Koyamada N, Nakano T. Effect of Preoperative Oral Antibiotics and Mechanical Bowel Preparations on the Intestinal Flora of Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Single-Center Prospective Pilot Study. Cureus 2024; 16:e52959. [PMID: 38406026 PMCID: PMC10894073 DOI: 10.7759/cureus.52959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION In the last few decades, considerable progress has been made in controlling surgical site infections (SSIs) using a combination of mechanical and oral antibiotic bowel preparation. However, the number of bacteria present after bowel preparation has not been clarified. In this study, we investigated the bacterial cultures of intestinal fluid samples from patients undergoing laparoscopic surgery for colorectal cancer after preoperative bowel preparation. METHODS This prospective observational study was designed as a pilot study at a single center. We enrolled 25 consecutive patients who underwent laparoscopic surgery for colorectal cancer between March 2021 and February 2022 at our institution. RESULTS The rate of bacterial culture positivity was 56.0%. The most abundant bacterium was Escherichia coli (44.0%). The positivity rates for E. coli on the right and left sides were 54.5% and 35.7%, respectively (P = 0.60). Moreover, there was a significant relationship between a low American Society of Anesthesiologists Physical Status score and E. coli positivity on the right side (P = 0.031). In the left-sided group, female sex and large tumor size were significantly associated with E. coli positivity (P = 0.036 and 0.049, respectively). Superficial SSI occurred in the patient in the left-sided group, but E. coli was negative. CONCLUSION This study emphasizes the importance of understanding intestinal fluid contamination and its relationship to infection risk. Future prospective multicenter studies should be conducted to determine the association between intestinal bacteria and different types of preoperative preparation.
Collapse
Affiliation(s)
- Sho Fujiwara
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, JPN
- Department of Surgery, Columbia University Irving Medical Center, New York, USA
| | - Kenji Kaino
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, JPN
| | - Kazuki Iseya
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, JPN
- Department of Surgery, Mito Medical Center, Ibaraki, JPN
| | - Nozomi Koyamada
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, JPN
| | - Tatsuya Nakano
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, JPN
- Department of Surgery, Iwate Prefectural Ofunato Hospital, Ofunato, JPN
| |
Collapse
|
4
|
Lepiane P, Balla A, Licardie E, Saraceno F, Alarcón I, Scaramuzzo R, Guida A, Morales-Conde S. Extracorporeal Hand-Sewn vs. Intracorporeal Mechanic Anastomosis During Laparoscopic Right Colectomy. JSLS 2022; 26:JSLS.2022.00039. [PMID: 36071998 PMCID: PMC9385111 DOI: 10.4293/jsls.2022.00039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives To compare the outcomes of extracorporeal hand-sewn side-to-side isoperistaltic ileocolic anastomosis (EHSIA) versus intracorporeal mechanic side-to-side isoperistaltic ileocolic anastomosis (IMSIA) during laparoscopic right hemicolectomy for adenocarcinoma. Methods This is a retrospective propensity score-matched analysis of prospectively collected data. Fifty-four patients who underwent surgery with EHSIA (intervention group) were paired with 54 patients who underwent surgery with IMSIA (control group) based on patients' demographics and type of surgery (standard right hemicolectomy or extended right hemicolectomy). Results Fifty-four patients were included for each group. Statistically significant differences between groups were not observed in patients' demographics and type of surgery. Conversion occurred in three patients of the intervention group due to intra-abdominal adhesions for previous surgery (5.6%) (p = 0.079). Median operative time was statistically significant shorter in the control group in comparison to the intervention group (85 and 117.5 minutes, respectively, p ≤ 0.0001). In both groups one anastomotic leakage was observed (1.9%) (Clavien-Dindo grade III-a). In the control group one patient (1.9%) underwent reintervention for acute postoperative anemia (Clavien-Dindo grade III-b). Median number of harvested lymph-nodes was 17 and 12 (p ≤ 0.0001), in the intervention and the control group, respectively. Median hospital stay was statistically significant lower in the control group in comparison to the intervention group (5 and 6.5 days, respectively, p ≤ 0.013). Conclusion IMSIA showed lower operative time and hospital stay in comparison to EHSIA. Further randomized studies are required to draw definitive conclusions about the best anastomotic technique during laparoscopic right hemicolectomy.
Collapse
Affiliation(s)
- Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain
| | - Rosa Scaramuzzo
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Anna Guida
- UOC of General and Minimally Invasive Surgery, Hospital San Paolo, Rome, Italy
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain
| |
Collapse
|