[Manual or mechanical right colon anastomosis?]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Surgical Innovation

Background:

• Ileocolic anastomosis is a critical step in right hemicolectomy for cancer.
• Assessing the optimal technique for ileocolic anastomosis is essential for patient outcomes.
• Minimizing anastomotic dehiscence is a key surgical goal.

Purpose of the Study:

• To compare the incidence of anastomotic dehiscence between mechanical and various manual ileocolic anastomosis techniques.
• To evaluate the safety and efficacy of different anastomosis methods after right hemicolectomy for cancer.

Main Methods:

• A prospective, randomized, multidepartmental pragmatic trial involving 140 patients.
• Comparison of four manual and one mechanical ileocolic anastomosis techniques.
• Primary outcome: anastomotic dehiscence assessed clinically or via Gastrograffine follow-through on postoperative day 10.

Main Results:

• Mechanical anastomosis showed a lower incidence of anastomotic dehiscence compared to most manual techniques.
• The terminolateral anastomosis with separate stitches using slow-absorption sutures was comparable to mechanical anastomosis.
• Fewer intraoperative septic factors were observed in the mechanical anastomosis group.

Conclusions:

• Mechanical ileocolic anastomosis is recommended after right hemicolectomy for cancer due to lower dehiscence rates.
• Manual terminolateral anastomosis with separate stitches is a viable alternative.
• Despite higher cost, mechanical anastomosis offers improved safety outcomes.