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Updated: Jul 3, 2026
Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node Dissection
Published on: January 9, 2026
Comparing access routes and anastomotic techniques for right-sided colonic resections: meta-analysis of randomized
Claudius Kessler1,2, Michael Santl1,3, Pascal Probst4
1Department of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.
Background:
There are numerous techniques for right-sided colonic resections with primary ileocolic anastomosis. This study investigated the impact of various access routes and different anastomotic techniques on short- and long-term outcomes.
Methods:
A systematic literature search was performed in CENTRAL (Cochrane Central Register of Controlled Trials), PubMed, and Web of Science (last search December 15, 2025). All randomized clinical trials (RCTs) investigating surgical techniques for right-sided colonic resections (i.e., ileocecal resection, right hemicolectomy) were reviewed. A meta-analysis (random-effects model) was conducted. Risk of bias (Cochrane 2.0) and certainty of evidence (GRADE) were assessed.
Results:
Thirty-three RCTs with 3787 patients were included. Twelve RCTs (1552 patients) compared open with laparoscopic surgery. Open surgery may result in shorter operation time (MD - 38.75 min, 95% CI: - 60.24 to - 17.26, p < 0.01, I2 = 99%, GRADE = low). However, it likely increases postoperative overall complications (OR 1.79, 95% CI: 1.27 to 2.52, p < 0.01, I2 = 0%, GRADE = moderate) and hospital stay (MD 1.23 days, 95% CI: - 0.25 to 2.71, p = 0.10, I2 = 86%, GRADE = low). Ten RCTs (1025 patients) compared extracorporeal with intracorporeal anastomosis. An extracorporeal anastomosis may result in shorter operation time (MD - 12.71 min, 95% CI: - 24.84 to - 0.59, p = 0.04, I2 = 85%, GRADE = low). However, it likely increases postoperative surgical site infections (OR 3.04, 95% CI: 1.36 to 6.80, p < 0.01, I2 = 0%, GRADE = moderate) and hospital stay (MD 0.62 days, 95% CI: 0.05 to 1.19, p = 0.03, I2 = 90%, GRADE = low). With respect to the anastomotic technique, no significant differences in outcomes were observed in 13 RCTs (1385 patients) comparing hand-sewn with stapled anastomosis, in 9 RCTs (673 patients) comparing end to end with side to side anastomosis, and in 10 RCTs (1076 patients) comparing isoperistaltic with antiperistaltic anastomosis.
Conclusions:
This comprehensive systematic review provides level 1a evidence on access routes and anastomotic techniques for right-sided colonic resections. The evidence supports a laparoscopic approach with an intracorporeal anastomosis. However, the evidence does not favor a particular anastomotic technique.
Registration:
CRD42024543620 (PROSPERO).
