Intracorporeal anastomosis versus extracorporeal anastomosis for laparoscopic right hemicolectomy: short-term and long-term outcomes
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Updated: Jul 15, 2026
Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node Dissection
Published on: January 9, 2026
Zach Sagorin1, Danlin Zeng2, Nam Nguyen2,3
1Faculty of Medicine, Department of Surgery, University of British Columbia, 2775 Laurel Street, 11th floor, Vancouver, BC, V5Z 1M9, Canada. zsagorin@student.ubc.ca.
Background:
Laparoscopic right hemicolectomy is the standard of care for non-locally advanced right-sided colonic neoplasms and endoscopically unresectable polyps amenable to laparoscopic resection, but the optimal ileocolic anastomotic technique remains debated. This study compares intracorporeal anastomosis (ICA) and extracorporeal anastomosis (ECA) outcomes in laparoscopic right hemicolectomy performed by three surgeons at a Canadian community hospital.
Methods:
This retrospective study analyzed patients who underwent elective laparoscopic right hemicolectomy with ICA using Pfannenstiel extraction or ECA using midline extraction at a Canadian community hospital from January 1, 2015, to December 31, 2023. Descriptive statistics, univariable, and multivariable Firth penalized logistic regression were performed to identify predictors of postoperative outcomes.
Results:
Of 203 patients, 150 (73.9%) underwent ICA and 53 (26.1%) had ECA. No significant differences in baseline characteristics were observed between groups. Operative times were similar (ICA: 151.9 min vs. ECA: 146.1 min, p = 0.319). ICA was associated with faster gastrointestinal recovery (first flatus: 2.0 vs. 3.5 days, p < 0.001), shorter hospital stays (2.8 vs. 5.0 days, p < 0.001), and lower rates of ileus (5.3% vs. 24.5%, p < 0.001), incisional hernia (0.0% vs. 7.5%, p = 0.004), and adhesive small bowel obstruction (0.0% vs. 5.7%, p = 0.017). No anastomotic leaks occurred in either group. On multivariable Firth regression, ECA was an independent predictor of postoperative complications (aOR 2.60, 95% CI 1.27-5.34), ileus (aOR 6.38, 95% CI 2.50-17.44), incisional hernia (aOR 30.16, 95% CI 3.17-3928.8), and adhesive SBO (aOR 20.86, 95% CI 1.97-2823.4).
Conclusions:
ICA was associated with faster recovery of bowel function, fewer complications, and shorter hospital stays compared to ECA, with comparable operative times. These findings support ICA as a feasible technique for ileocolic anastomosis in a community hospital setting and suggest it is associated with improved short- and long-term outcomes compared to ECA.
