Comparative analysis of intracorporeal and extracorporeal anastomotic techniques in laparoscopic right colectomy: assessment of surgical safety and short-term outcome

Background. Restoration of intestinal continuity after laparoscopic right colectomy may be performed with either intracorporeal (IA) or extracorporeal (EA) anastomosis. The surgical safety of IA remains under active investigation. The aim of this study was to evaluate the outcomes of IA in oncological patients undergoing laparoscopic right colectomy. Methods. A retrospective cohort study was conducted using a prospectively maintained database (June 2018 — December 2023), including patients with colon cancer who underwent laparoscopic right colectomy. Surgical outcomes were compared between the IA and EA groups. Results. A total of 701 patients were included: 649 in the IA group and 52 in the EA group. The groups were comparable in terms of age (p=0.353), sex (p=0.418), body mass index (p=0.583), and number of comorbidities (p=0.784). Earlier recovery of bowel function was observed in the IA group: median of 4 vs. 5 days to first stool (p<0.001). Anastomotic leak rates did not differ significantly between the IA and EA groups: 1.5% vs. 5.8% (p=0.065). Major postoperative complications (Clavien—Dindo ≥IIIA) occurred significantly less frequently with IA: 6.3% vs. 23.1% (p<0.001). IA was associated with a reduced risk of major complications, with an odds ratio of 0.31 (95% CI: 0.14—0.69) after adjustment for other factors. In subgroup analysis, the association between IA and fewer major postoperative complications was most pronounced in patients with obesity: odds ratio of 0.08 (95% CI: 0.02—0.30). Conclusion. Intracorporeal anastomosis in laparoscopic right colectomy is associated with faster recovery of bowel function, does not increase the risk of anastomotic leakage, and reduces the rate of major postoperative complications, particularly in patients with obesity. Mastery of the IA technique may become an important component of colorectal surgical training, offering patients a more favourable postoperative course.