SP 5.04 Intracorporeal Vs Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Nirmani Widanage, Amila Wickramasinghe, Kasun GunathilakeAbstract
Aims
Intracorporeal anastomosis (ICA) is increasingly used in laparoscopic right hemicolectomy and may offer advantages in wound morbidity and postoperative recovery compared with extracorporeal anastomosis (ECA).
Methods
A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. Randomized controlled trials (RCTs) from 1 January 2011 to 1 January 2026 comparing ICA and ECA. PubMed, Embase, Web of Science, and the Cochrane Library were searched for RCTs assessing ICA versus ECA in adults undergoing laparoscopic right hemicolectomy. Primary outcomes were anastomotic leak, surgical site infection (SSI), and incisional hernia. Secondary outcomes were operative time and length of stay. Random-effects modelling generated pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). Risk of bias was assessed using RoB2. Overall heterogeneity across pooled outcomes was low to moderate.
Results
Eight RCTs (760 patients) met inclusion criteria. ICA and ECA had comparable anastomotic leak rates (RR 0.95, 95% CI 0.61–1.45). ICA was associated with fewer SSIs (RR 0.72, 95% CI 0.54–0.96) and a lower incidence of extraction-site hernia (RR 0.65, 95% CI 0.42–1.00). ICA required slightly longer operative time (MD +11.2 minutes, 95% CI +4.3 to +18.1) but resulted in shorter hospital stay (MD –0.6 days, 95% CI –1.0 to –0.2). Risk of bias was generally low.
Conclusion
Across 15 years of randomized evidence, intracorporeal anastomosis improves wound outcomes and recovery without compromising anastomotic safety. These findings support its broader implementation in minimally invasive right hemicolectomy.