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Park et al. Mini-invasive Surg 2020;4:87 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.87

Meta-Analysis Open Access

A systematic review and meta-analysis comparing
intracorporeal anastomosis and extracorporeal

anastomosis in minimally invasive colectomies

Sean S. W. Park , Daniel Feng , Stephen Smith
5,6
1,2
3,4
1 Department of General Surgery, John Hunter Hospital, Newcastle, New South Wales 2305, Australia.
2 School of Medicine and Public Health, University of Edinburgh, Edinburgh EH8 9AB, United Kingdom.
3 Department of General Surgery, Westmead Hospital, Sydney, New South Wales 2145, Australia.
4 School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales 2308, Australia.
5 Department of General Surgery, John Hunter Hospital, Newcastle, New South Wales 2305, Australia.
6 School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales 2308, Australia.

Correspondence to: Dr. Daniel Feng, Westmead Hospital, Hawkesbury Rd, Westmead, New South Wales 2145, Australia.
E-mail: d.feng1996@gmail.com

How to cite this article: Park SSW, Feng D, Smith S. A systematic review and meta-analysis comparing intracorporeal anastomosis
and extracorporeal anastomosis in minimally invasive colectomies. Mini-invasive Surg 2020;4:87.
DOI: 10.20517/2574-1225.2020.87

Received: 30 Aug 2020 First Decision: 12 Oct 2020 Revised: 19 Oct 2020 Accepted: 30 Oct 2020 Published: 5 Dec 2020

Academic Editor: Simon Ng Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Aim: This systemic review aims to determine if intracorporeal anastomosis (IA) adds value to patient outcomes
without compromising operative and oncological safety when compared to extracorporeal anastomosis (EA) in
laparoscopic colectomies. This is the first systematic review with meta-analysis to evaluate the outcomes in a
combined fashion including both laparoscopic right and left colectomies.

Methods: A systematic review of Medline, EMBASE, Cochrane Library, and PubMed was performed on studies
analysing direct comparison between IA and EA. The primary outcome was anastomotic leakage. Quality
assessment was carried out using a modified Institute of Health Economics appraisal tool. Meta-analysis was
performed using a random-effects model.

Results: A total of 24 papers with 2,674 patients were included in the analysis. No significant difference was found
in anastomotic leakage (OR = 0.84; 95%CI: 0.54-1.31; P = 0.44) and short-term mortality (OR = 0.56; 95%CI:
0.20-1.58; P = 0.27) between the IA and EA cohorts. The IA cohort was associated with faster return of bowel
function [MD = -0.53 days; 95%CI: -0.67-(-0.39); P < 0.00001] and lower incidence of surgical site infection

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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