**2.1 Anastomotic techniques**

There are two ways to perform ileocolic anastomosis: extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA). In the EA a Kocher or middle-line or Pfannenstiel incision is made, protected with an Alexis device. The ileum and the colon are extracted, the dissection of the mesocolon is continued and, if necessary, the isolation of the arcade vessels is finished; the transection of ileum and colon is performed with a 60 mm GIA stapler, and the specimen is separated. A side-to-side

**Figure 4.** *Section of ileum (left) and colon (right).*

**Figure 5.** *Enterotomy for insertion of stapling device.*

**109**

anastomosis.

**Figure 7.**

**outcome**

reducing the operative time [11].

*Laparoscopic Right Colectomy. Intracorporeal Anastomosis Is Associated with Better Outcome*

isoperistaltic or antiperistaltic anastomosis is created with a 60 mm GIA stapler and it is reinforced with continuous suture. In IA, the entire procedure (vascular ligation, colon and ileum section and anastomosis) is performed intracorporeally: ileum and the transverse colon are transected using an Endo-GIA stapler and the piece is placed over the liver. Ileum and colon are moved close, an enterotomy is

A side-to-side isoperistaltic or antiperistaltic anastomosis is created with the 60 mm endostapler; after that, the enterotomy is closed with continuous suture as shown in **Figure 6** (by Stein and Bergamaschi [5]). In this phase, we usually use 2–0 prolene). In **Figure 7** is showed the final result of intracorporeal ileocolic

The specimen is extracted through a Pfannenstiel incision, which is protected with an Alexis device. After performing anastomosis, 2 tubular drainages are placed: one of them near to anastomosis and the other in pelvic cavity. These devices can be removed, if no complications occurred, 3–5 days after surgery [6].

**3. Intracorporeal or extracorporeal anastomosis: differences in clinical** 

When an anastomosis has been performed, the main complication that surgeons try to avoid is anastomotic leakage (AL) which means that bowel content can move from bowel lumen into abdominal space. In EA, despite the entire operation is carried out laparoscopically, the anastomosis is comparable to that performed during open surgery. The IA has been proved safe by several study, showing no statistically significant difference in AL rate between IA and EA [7]. A recent international snapshot audit [8] has identified 3 surgeon-dependent variables significantly associated with AL: duration of surgery, surgical approach, and anastomotic technique. Regarding duration of surgery, operating time varied widely: Magistro et al. [9] reported a significant longer duration of surgery for IA. Although the IA technique is retained faster by some [10], most studies showed no significant difference. However, it has been shown that the learning curve plays a major role in

Laparoscopic approach decreases morbidity and mortality after colorectal resection [4, 12]. Similarly, a laparoscopic approach is associated also with a lower AL rate compared with an open approach [8]. Considering anastomotic technique, the last Cochrane review [13] concluded that stapled ileocolic anastomosis was associated with fewer leaks than handsewn anastomosis. Two large observational

*DOI: http://dx.doi.org/10.5772/intechopen.93996*

performed (**Figure 5**) to allow insertion of stapler.

*Completed side-to-side intracorporeal ileocolic anastomosis.*

**Figure 6.** *(A) Stapled ileocolic anastomosis; (B) Hand-sewing of enterotomy after stapler removal.*

*Laparoscopic Right Colectomy. Intracorporeal Anastomosis Is Associated with Better Outcome DOI: http://dx.doi.org/10.5772/intechopen.93996*

**Figure 7.** *Completed side-to-side intracorporeal ileocolic anastomosis.*

*Colorectal Cancer*

**2.1 Anastomotic techniques**

There are two ways to perform ileocolic anastomosis: extracorporeal anastomosis

(EA) and intracorporeal anastomosis (IA). In the EA a Kocher or middle-line or Pfannenstiel incision is made, protected with an Alexis device. The ileum and the colon are extracted, the dissection of the mesocolon is continued and, if necessary, the isolation of the arcade vessels is finished; the transection of ileum and colon is performed with a 60 mm GIA stapler, and the specimen is separated. A side-to-side

**108**

**Figure 6.**

**Figure 5.**

**Figure 4.**

*Enterotomy for insertion of stapling device.*

*Section of ileum (left) and colon (right).*

*(A) Stapled ileocolic anastomosis; (B) Hand-sewing of enterotomy after stapler removal.*

isoperistaltic or antiperistaltic anastomosis is created with a 60 mm GIA stapler and it is reinforced with continuous suture. In IA, the entire procedure (vascular ligation, colon and ileum section and anastomosis) is performed intracorporeally: ileum and the transverse colon are transected using an Endo-GIA stapler and the piece is placed over the liver. Ileum and colon are moved close, an enterotomy is performed (**Figure 5**) to allow insertion of stapler.

A side-to-side isoperistaltic or antiperistaltic anastomosis is created with the 60 mm endostapler; after that, the enterotomy is closed with continuous suture as shown in **Figure 6** (by Stein and Bergamaschi [5]). In this phase, we usually use 2–0 prolene). In **Figure 7** is showed the final result of intracorporeal ileocolic anastomosis.

The specimen is extracted through a Pfannenstiel incision, which is protected with an Alexis device. After performing anastomosis, 2 tubular drainages are placed: one of them near to anastomosis and the other in pelvic cavity. These devices can be removed, if no complications occurred, 3–5 days after surgery [6].
