Minimizing incisional hernia: intracorporeal anastomosis makes the difference after laparoscopic right colectomy

The anastomosis technique following laparoscopic right colectomy remains a subject of ongoing debate. One of the potential advantages of intracorporeal anastomosis is the flexibility it offers in selecting the location of the minilaparotomy. This study aimed to evaluate the differences in the rate of incisional hernia between intracorporeal and extracorporeal anastomosis after laparoscopic right colectomy.

We retrospectively analysed patients undergoing laparoscopic right colectomy for colon neoplasia between April 2013 and January 2024, retrieved from a prospectively maintained database. The occurrence of incisional hernia was assessed according to the anastomosis technique. Univariate and multivariate analyses were performed to investigate the relationship between incisional hernia and anastomosis technique, while controlling for other risk factors.

Among 192 patients, 94 underwent intracorporeal anastomosis and 98 underwent extracorporeal anastomosis. The groups were comparable in terms of clinical, pathological, and surgical data. The intracorporeal group showed a lower incidence, although not statistically significant, of postoperative ileus (p = 0.052), and a shorter hospital stay (p = 0.003). No incisional hernias were observed at the minilaparotomy site in the intracorporeal anastomosis group, while 13.3% of patients in the extracorporeal anastomosis group developed an incisional hernia (p < 0.001). One incisional hernia at the umbilical trocar site occurred after intracorporeal anastomosis. Multivariate analysis identified postoperative general complications (OR [95% CI]: 4.1 [1.0-16.5], p = 0.049) and extracorporeal anastomosis (OR [95% CI]: 15.4 [1.0-126.9], p = 0.011) as independent risk factors for incisional hernia.

Intracorporeal anastomosis significantly reduces the incidence of incisional hernia at the minilaparotomy site. This finding is further supported by logistic regression analysis, which identified intracorporeal anastomosis as a significant and independent protective factor against incisional hernia.