الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
While laparoscopic approach for right hemicolectomy is considered appropriate for the surgical treatment of both malignant and benign diseases of the right colon, there is still debate about how to perform the ileo-colic anastomosis (Rausa E et al., 2019). With the development of this minimally invasive approach, intracorporeal anastomosis (ICA) was introduced as an alternative to extracorporeal anastomo¬sis (ECA) to restore continuity of the colon after resection. Over the years, some studies have shown improved postoperative outcomes with ICA as compared with ECA with similar morbidity and mortal¬ity (Aiolfi A et al., 2020). The aim of this study is to compare the perioperative outcomes of extra-corporeal and intra-corporeal anastomosis after laparoscopic right hemicolectomy for various right sided colonic lesions. This study was conducted in Gastrointestinal surgery center (GISC), a tertiary referral center, Mansoura University. The study was accepted by Institutional Research Board (IRB) with a code number (MD.22.06.656). This study is a combined retrospective and prospective propensity score matched analysis designed for patients who undergo laparoscopic right hemicolectomy for various right colon lesions. This study aims to determine the impact of anastomotic technique (extra-corporeal versus intra-corporeal) on different perioperative outcomes after laparoscopic right hemicolectomy. Results: We included a total of 90 cases who underwent laparoscopic resection for right colon lesions during the study period. All our cases were performed in an elective session. Total laparoscopic approach with ICA was the commonest approach used in 58 cases (57.8%), while laparoscopic approach with ECA was used in 38 cases (42.2%). After applying propensity score matching (PSM), each group included 21 cases only. Recovery of bowel functions was faster in ICA group (2 days vs. 3 days in the other group respectively, P =0.045), which allowed early oral intake in ICA group at the 3rd POD compared to 4th POD in the other group, P =0.002. Post operative hospital stay was significantly shorter in ICA group (P = 0.004). Morbidity was slightly higher in ECA group 11 cases (52.4%) compared to 4 cases in ICA group (19%). Anastomotic leakage and post operative collection were encountered in a single case (4.8%) in each group, all needed re-exploration and stoma. Post operative ileus was encountered in 10 cases (47.6%) in ECA group compared to 3 cases only (14.3%) in the other group (P =0.043). Wound infection was noticed more frequently with ECA group 5 cases (23.8%) vs. 1 case (4.8%) in the other group (P = 0.078), all underwent bed side management. Conclusion: It was evident from our study that the laparoscopic approach for right hemicolectomy with ICA has some advantages over the ECA approach especially regarding post-operative course and morbidity.