Intracorporeal Versus Extracorporeal Anastomosis in Minimally Invasive Ileocecectomy or Ileocolic Resection for Crohn's Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Minimally invasive right colectomy is a standard treatment for Crohn's disease. Although intracorporeal anastomosis (ICA) has shown favorable outcomes in minimally invasive colorectal surgery, evidence specific to Crohn's disease remains limited. We performed the first systematic review and meta-analysis comparing ICA and extracorporeal anastomosis (ECA) in this setting. METHODS: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched from database inception through June 2026 for comparative studies evaluating ICA versus ECA in adult patients undergoing minimally invasive ileocecectomy or ileocolic resection for Crohn's disease. Random-effects meta-analyses were performed using odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was assessed using ROBINS-I, and certainty of evidence was evaluated with the GRADE approach. RESULTS: Four retrospective cohort studies involving 672 patients (186 ICA and 486 ECA) were analyzed. ICA significantly reduced overall postoperative complications compared with ECA (OR: 0.44, 95% CI: 0.28-0.70; P < .001; I2 = 0%). Anastomotic leak, surgical site infection, 30-day readmission, length of hospital stay, clinical recurrence, endoscopic recurrence, and surgical recurrence were comparable between groups. Operative time was longer with ICA (MD 70.2 minutes, 95% CI: 55.2-85.2; P < .001). CONCLUSION: ICA was associated with fewer postoperative complications than ECA during minimally invasive ileocolic resection for Crohn's disease, without increasing anastomotic failure, hospital stay, or disease recurrence, although operative time was longer.