Short summary

Intracorporeal laparoscopic anastomoses is widely used in the bariatric surgery, but has only recently been introduced to colonic resections. The technique has been used during colonic resections in Hospital South West Jutland since June 2015. The aim of our project is to investigate the safety and possible advantages of intracorporeal laparoscopic anastomoses in colonic resections, here right- and extended right hemicolectomies, left hemicolectomies, ileocolic resections and sigmoideostomy takedowns.

Rationale

Intracorporeal laparoscopic anastomoses (IA) is a widely used technique in the bariatric surgery, and is the standard procedure during gastric bypass. The technique is rather new in colonic surgery and data is therefore limited. The method implies intracorporeal laparoscopic suture of the two intestinal ends after resection of the desired colon, instead of the conventional extracorporeal suturing. The present studies are mostly retrospective and are investigating IA in right hemicolectomies. These studies are finding shorter time to discharge and shorter time to bowel movement compared to extracorporeal anastomoses (EA).

The anastomotic leakage-risk in segmental colonic resections among cancer-patients in Denmark is, according to the Danish Colorectal Cancer Group, 4.3 %. The present studies are not finding significant differences in leakage-rate, severe complications or mortality in IA during right hemicolectomies compared to EA. A single study finds significantly lower complication-rate in the IA-group but no significant differences in severe complications.

During laparoscopic right hemicolectomy using IA, the anastomosis can be made without mobilizing the transverse colon and thereby avoid traction of the mesocolon compared to EA, where small bowel and transverse colon is pulled out using an incision in the upper abdomen. The patient's risk of developing hypotension, in this case known as mesenteric traction syndrome, is thus lowered. This is one of the justifications in preferring IA compared to EA, where traction of the two intestinal ends can be considerable. 

It is furthermore obvious to assume an advantage in using a muscle-sparring Pfannenstiel incision during IA, compared to the upper-abdominal incision during EA. The advantage in this situation would be less postoperative pain and lower risk of developing postoperative abdominal hernia. Since July 2015, IA has been the standard procedure in Surgical Department of Hospital South West Jutland in segmental colonic resections, where right- and extended right hemicolectomies are the majority of the operations.

Description of the cohort

The cohort consists of patients who had a laparoscopic intracorporeal anastomosis performed. The operation-types included are right- and extended right hemicolectomies, left hemicolectomies, ileocolic resections and sigmoideostoma takedowns. Robotic assisted operations are included as well. Both acute and scheduled operations were enrolled.

Data and biological material

Data about the patients' preoperative status, comorbidity, weight, height, alcohol- and tobacco-consumption are collected. Peroperative data regarding the surgical technique such as stapling-instruments, anastomosis-type and peroperative events are collected. Furthermore a more detailed postoperative data-collection is performed involving time to mobilization, bowel-movement and discharge of the patient. Postoperative complicationas are also registered

Collaborating researchers and departments

Department of Surgery, Odense University Hospital

• Clinical associate professor Mark Bremholm Ellebæk, PhD

Department of Surgery, Hospital South West Jutland

• MD Musa Büyükuslu

Department of Surgery, Hospital Svendborg

• MD Thomas Buchbjerg