Estudio prospectivo randomizado comparando anastomosis latero-lateral isoperistáltica versus antiperistáltica tras hemicolectomia derecha laparoscópica por cáncer

Resumo

The main complexity of the right hemicolectomy is in the performance of the ileocolic anastomosis due to the scarce standardization of the technique. There are many articles comparing the disposition of bowel loops, suture technique and place of execution, but there are no well-designed studies about the role of peristalsis in this anastomosis. A prospective randomized study was conducted in patients undergoing scheduled surgery for right colon cancer with laparoscopic right hemicolectomy and reconstruction with iso- or antiperistaltic ileocolic anastomosis. Primary endopoint was to compare short and long term results in terms of postoperative morbidity and mortality. Secondary endpoint was to compare quality of life between both groups using the Gastrointestinal Quality Life Index (GIQLI). One hundred and eight patients were included (54 per treatment branch). There were no significant differences in the demographic variables. Regarding surgical variables, no differences were found in conversion rate (p = 0.500) nor in the total surgical time (130 [120-150] min in isoperistaltic vs 140 [127-160] in antiperistaltic, p = 0.481) or anastomotic time (19 [17-22] vs. 20 [16-25], p = 0.207). Regarding postsurgical complications 37.0% of patients in the isoperistaltic group and 40.7% in the antiperistaltic group had some type of complication, without differences between them (p = 0.693). Although no significant differences were found, the isoperistaltic group presented a higher rate of paralytic ileus compared to the antiperistaltic one (14.8% vs. 5.6%). During the postoperative period, the antiperistaltic group showed better results with shorter time until first flatus and until first deposition (p = 0.004 and p = 0.017). However, this did not mean a shorter hospital stay (p = 0.236). In the term results, there are no significant differences in complications or in chronic diarrhea rates one year after surgery (p = 0.541). GIQLI scores were similar between both groups at month, 6 months and a year after surgery, without differences between both groups (p = 0.154, p = 0.498 and p = 0.683 respectively). In conclusion, isoperistaltic and antiperistaltic ileocolic anastomosis are as safe and feasible as there are no differences in the postoperative safety variables or in the results of the quality of life test.