• Roberto Cirocchi, Stefano Trastulli, Eriberto Farinella, Salvatore Guarino, Jacopo Desiderio, Carlo Boselli, Amilcare Parisi, Giuseppe Noya, and Karem Slim.
• Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. cirocchiroberto@yahoo.it
• Surg Oncol. 2013 Mar 1; 22 (1): 1-13.

BackgroundSince 2005, after an initial scanty spreading, the vast majority of surgeons advice against the intracorporeal ileocolic anastomosis following right hemicolectomies. In the subsequent years, greater interest was re-discovered for the intracorporeal ileocolic anastomosis formed after video-assisted right hemicolectomiesObjectiveThe aim of this systematic review is to compare the intra-abdominal versus extra-abdominal anastomosis after right laparoscopic colectomy.Data SourcesA systematic search was conducted in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central and the Science Citation Index.Study SelectionA total of 191 publications were identified; seven non-randomized studies published between 2004 and 2012 with a total of 945 patients, who underwent laparoscopic right colectomy for malignant and benign disease, were included in this systematic review.InterventionIntra-abdominal versus extra-abdominal confectioning of ileo-coloc anastomosis after right laparoscopic colectomy.Main Outcome MeasuresAnastomotic leak, overall post-operative morbidity and overall 30-days post-operative mortality.ResultsAnastomotic leak rate resulted similar in IA (1.13%) and EA (1.84%) group (P=0.81, OR of 0.90, 95% CI 0.24-3.10) (Chi(2)=3.90, P=0.42, I(2)=0%). The mortality rate was lower in the IA group (0.34% versus 1.32%), although no statistically difference was demonstrated between the two groups (P = 0.48, OR of 0.52 95% CI 0.09-3.10). It was not possible to conduct a meta-analysis of post-operative morbidity as the data reported in the included studies were too heterogeneous.LimitationsThe weakness in our results was due to the lack of evidence in current published literature.ConclusionsThe present systematic review of literature and meta-analysis failed to solve the controversies between intracorporeal and extracorporeal anastomosis after laparoscopic right hemicolectomy. Future randomized, controlled trials are needed to further evaluate different surgical anastomosis after laparoscopic right hemicolectomy.Copyright © 2012 Elsevier Ltd. All rights reserved.

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