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Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 179-186

Laparoscopic colectomy with intracorporeal anastomosis using endostaplers: Surgical technique description

1 Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
2 Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA

Correspondence Address:
Anthony Dippolito
Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania 18015
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-5568.196878

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Background and Objectives: Published evidence suggests that colorectal laparoscopic surgery is similar to conventional open surgery in terms of oncological safety. Here, we describe our experience performing a laparoscopic right hemicolectomy with an intracorporeal anastomosis using endostaplers (LRH-IAE). Methods: A retrospective review of patients who underwent LRH-IAE from February 2008 to May 2012 was performed. Demographic, intraoperative, and postoperative data were collected. Key end-points included open conversion rates, adequacy of oncologic resection, and 30-day morbidity and mortality. Results: A total of 27 LRH-IAE procedures were performed during the study period. Median patient age was 74 years, with 12 females and 15 males. Most common indications for surgery included colonic mass (74.1%, n = 20) and incomplete polypectomy (14.8%, n = 4). The median American Society of Anesthesiologists score was 3 (interquartile range [IQR]: 2–3) and median operative time was 312 min (IQR: 200–420 min). There were no conversions to open laparotomy. Surgical margins were negative in all patients, with a median of 17 lymph nodes examined per specimen. Nine patients experienced postoperative morbidity, including cardiac (7.4%, n = 2), pulmonary (18.5%, n = 5), and abdominal (22.2%, n = 6) complications. Abdominal complications included ileus (3.7%, n = 1), perforated viscus/leak (7.4%, n = 2), anastomotic stricture (3.8%, n = 1), and an incisional hernia (7.4%, n = 2). All-cause 30-day mortality was 11.1% (3/27). The median length of stay was 5 days (range: 3–42 days). Conclusion: This report shows that LRH-IAE in high-risk surgical population is characterized by an acceptable risk-benefit profile. LRH-IAE offers the advantages of less tissue manipulation and adheres to established oncological principles. The following core competencies are addressed in this article: Medical knowledge and patient care.

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