Implementation of intracorporeal anastomosis in minimally invasive right hemicolectomy in Sweden—results from a nationwide survey
Håkan Ohlsson, Martin Rutegård, Pamela BuchwaldAbstract
Introduction
Minimally invasive right hemicolectomy is the standard treatment of adenocarcinoma in the proximal colon but the optimal method for ileocolic anastomosis, intracorporeal (IA) or extracorporeal (EA), remains debatable. In Sweden, current practice is unknown. This study aimed to map surgical practice and identify factors influencing the implementation of IA.
Methods
In November 2025, a survey was distributed to the heads of all 45 colorectal surgery units in Sweden. Completion rate was 100%. Survey data were integrated with publicly available surgical volume data from the Swedish Colorectal Cancer Registry. Linear regression was utilized to determine associations between IA implementation and annual case volume of right hemicolectomies, healthcare region, and implementation of minimally invasive surgery, including robotics.
Results
Of the 45 units, 38% primarily used IA, 31% EA, and 31% a mixed approach. IA implementation increased markedly from 10% of all minimal invasive right hemicolectomies in 2017 to 50% in 2024. Survey responses indicated that reduced mesenteric traction and lower risk of incisional hernia were primary drivers. Units with a higher proportion of minimally invasive right hemicolectomies were more likely to implement IA (P = 0.03), while neither annual surgical volume (P = 0.11) nor the use of robotic surgery (P = 0.45) predicted implementation.
Discussion
IA is rapidly gaining ground in Sweden, largely driven by the implementation of minimally invasive surgery. The findings provide an important baseline for future assessments of the clinical outcomes following wider IA implementation.