Key techniques and focal issues of digestive tract reconstruction in laparoscopic right hemicolectomy
10.7659/j.issn.1005-6947.2024.10.007
- VernacularTitle:腹腔镜右半结肠切除术消化道重建的关键技术和焦点问题
- Author:
Shiqi GUO
1
;
Hong ZHANG
Author Information
1. 中国医科大学附属盛京医院普通外科结直肠肿瘤外科,辽宁沈阳 110004
- Keywords:
Colectomy;
Anastomosis,Surgical;
Anastomotic Leak
- From:
Chinese Journal of General Surgery
2024;33(10):1600-1612
- CountryChina
- Language:Chinese
-
Abstract:
Laparoscopic right hemicolectomy(LRC)has evolved over the past 30 years,and its oncological efficacy has validated by numerous high-quality studies.Researchers are exploring ways to enhance the quality and safety of LRC while maintaining oncological benefits.Clinical studies focused on surgical quality related to intraoperative anatomical concepts,anatomical planes,anatomical variations,and resection range have yielded significant results,leading to a more standardized and homogenized approach.However,there remains considerable debate on the ileocolonic digestive tract reconstruction during LRC.Currently,ileocolonic reconstruction can be divided into manual suturing and stapled anastomosis according to anastomosis techniques.According to anastomotic configuration,it can be divided into side-to-side,end-to-side,and end-to-end anastomoses.According to the position of the anastomotic operation,it can be divided into extracorporeal(via auxiliary incision)and intracorporeal(within the abdominal cavity)anastomoses.With the advancement of minimally invasive techniques and surgical instruments,intracorporeal side-to-side anastomosis using staplers is increasingly favored by surgeons.However,stapled anastomosis has not completely replaced manual suturing,and the debates over the advantages and disadvantages of these two techniques persist.Additionally,surgeons exhibit varying preferences for anastomotic configurations,and there is no consensus yet.Research on the pros and cons of intracorporeal versus extracorporeal anastomosis is more and more abundant and in-depth.Although high-quality studies addressing some of these issues have been published,some of the findings are controversial.This paper systematically examines the current state of research at home and abroad regarding various anastomosis techniques,the technical characteristics and selection criteria for different anastomotic configurations,and the pros and cons of intracorporeal versus extracorporeal anastomoses in terms of intraoperative handling,postoperative complications,oncological benefits,and healthcare costs.It also addresses key issues like whether to close the mesenteric hiatus.The purpose of this paper is to provide theoretical guidance for clinicians in selecting appropriate gastrointestinal reconstruction methods,optimizing surgical quality,and exploring new directions for clinical research.
