Intracorporeal Versus Extracorporeal Anastomsis In Laparoscopy Right Colectomy:A Meta-Analysis

Objective: The safety,effectiveness and prognosis of intracorporeal anastomosis(IA)and extracorporeal anastomosis(EA)in laparoscopic right colectomy(LRC)were compared.Methods: Search Pub Med,Embase,Cochrane,CNKI and other databases according to the search strategy,search the literature on laparoscopic right colectomy in intracorporeal and extracorporeal anastomosis published from January 2015 to July 2020,and screen the literature strictly according to the inclusion and exclusion criteria.The quality of the selected documents is evaluated,data is extracted from the documents that meet the conditions,and the Review Manager 5.3 is used for analysis.Results: A total of 16 studies(3151 patients)were included: 42.6%received IA surgery,57.4% received EA surgery,of which 3 were RCT(Randomized controlled trial)and 13 were RET(Retrospective study).The results of Meta analysis showed that compared with the EA group,the IA group had longer specimen length(WMD=2.97,95%[0.56,5.39],P=0.02);surgical incision length(WMD=-1.76,95%[-2.00,1.51],P<0.00001)shorter;first postoperative ventilation time(WMD=-0.62,95%[-0.75,-0.49],P<0.00001)earlier;overall complication rate(OR=0.64,95 %[0.47,0.87],P=0.005),incidence of minor complications(OR=0.65,95%[0.46,0.93],P=0.02),incidence of incision infection(OR=0.49,95%[0.35,0.70 ],P<0.0001),the incidence of postoperative intestinal obstruction(OR=0.53,95%[0.38,0.75],P=0.0003)and the rate of readmission 30 days after surgery(OR=0.60,95%[0.39,0.92],P=0.02)is lower;the length of the operation(WMD=13.11,95%[8.07,18.15],P<0.00001)is longer;the amount of blood loss in the operation(WMD=-8.47,95%[-21.03,4.10],P=0.19),rate of conversion to laparotomy(OR=0.74,95%[0.49,1.12],P=0.15),number of lymph node dissections(WMD=1.17,95%[-0.04,2.38],P=0.06),The incidence of serious complications(OR=0.71,95%[0.50,1.00],P=0.05),the incidence of anastomotic leakage(OR=0.82,95%[0.55,1.24],P=0.35)and postoperative mortality(OR=0.32,95%[0.09,1.07],P=0.07)and other conditions were not statistically significant.Conclusions:For the treatment of patients with right colon tumors,laparoscopic intracorporeal anastomosis of the right colon has a small incision,quick postoperative recovery,and fewer postoperative complications.Compared with extracorporeal anastomosis,the safety,effectiveness andprognosis of the operation are two.The results are equivalent,and the results are more conducive to in intracorporeal anastomosis,and the length of the in extracorporeal anastomosis operation is shorter,but we still need large samples and multicenter studies to confirm these results.