Federico Ghignone, Davide Zanotti, Margherita Minghetti, Francesca Rita Di Candido, Giacomo Frascaroli, Federico Mazzotti, Paola Tramelli, Davide Zattoni, Giampaolo Ugolini
Institutional standardization of intracorporeal anastomosis during laparoscopic right colectomy was associated with improved recovery and a marked reduction in extraction-site hernia without compromising postoperative safety. These findings suggest that standardizing surgical technique, alongside established enhanced recovery pathways, may represent an effective strategy for improving the quality of colorectal surgical care.
PURPOSE: Variation in surgical technique remains an important source of heterogeneity in postoperative outcomes after colorectal surgery. Although enhanced recovery pathways have standardized perioperative care, less attention has been devoted to the systematic standardization of surgical techniques. We evaluated whether the implementation of a standardized institutional program adopting intracorporeal anastomosis during laparoscopic right colectomy for cancer was associated with improved postoperative outcomes.
METHODS: This is a single center retrospective pre-post cohort study. The primary outcome was rate of incisional hernia at extraction site. Secondary outcomes included postoperative complications, reintervention, unplanned readmission and postoperative length of stay. Patients were stratified according to anastomotic technique. Multivariable regression models were used to adjust for clinically relevant confounders. A propensity score-matched analysis was performed to mitigate selection bias.
RESULTS: A total of 438 patients was included. Institutional implementation of intracorporeal anastomosis correlated with a lower rate of incisional hernia compared to extracorporeal (2.5% vs 13.1%, p<0.001). On adjusted analysis, intracorporeal anastomosis remained independently associated with reduced odds of incisional hernia (OR 0.15, 95% CI 0.05-0.46, p<0.001) and shorter length of stay. No significant differences were observed in overall complications, anastomotic leak, ileus, bleeding, reintervention, or readmission. These findings were consistent in the propensity score-matched cohort.
CONCLUSIONS: Institutional standardization of intracorporeal anastomosis during laparoscopic right colectomy was associated with improved recovery and a marked reduction in extraction-site hernia without compromising postoperative safety. These findings suggest that standardizing surgical technique, alongside established enhanced recovery pathways, may represent an effective strategy for improving the quality of colorectal surgical care.