Single-layer versus double-layer closure of the enterotomy in laparoscopic right hemicolectomy with intracorporeal anastomosis: a single-center study.

BACKGROUND: The aim of our study was to evaluate the short-term outcomes of totally laparoscopic right colectomy, in particular to compare the incidence of leakage of the ileocolic anastomosis after either single-layer (SL) or double-layer (DL) enterotomy closure. METHODS: From March 2010 to July 2014, 162 patients underwent laparoscopic right colectomy with intracorporeal ileocolic anastomosis. The enterotomy was closed with either SL (77 patients) or DL technique (85 patients). Short-term outcomes in both groups were retrospectively analyzed. RESULTS: Median time to perform the ileocolic anastomosis was similar in the two groups (17 min in SL versus 20 min in DL, p = 0.109). DL closure was associated with a significantly lower incidence of anastomotic leakage (1.2 % in DL vs 7.8 % in SL, p = 0.044). Shorter hospital stay was also observed in the DL group. CONCLUSIONS: Adoption of DL closure of the enterotomy resulted in significantly improved outcome. We strongly recommend a double-layer closure technique when performing an intracorporeal enterocolic anastomosis.

Open Veress Assisted technique. Results in 2700 cases.

AIM: The risks of specific complications of the laparoscopic technique, caused by pneumoperitoneum and by insertion of the first trocar, although rare, are frequently reported in literature. METHODS: A retrospective study of the complications we had in the period from October 1998 to December 2006 was made on 2700 patients who did not need any trocars in the umbilicus or with scars due to previous surgery, who were treated with a particular technique of pneumoperitoneum induction and the insertion of the first trocar, named ''Open Veress Assisted'' (OVA). RESULTS: We had two visceral complications (0,07%) (ileal perforations). CONCLUSION: Although no surgical technique is without risks, we believe that the use of our technique is safer than a blind insertion of the first trocar, especially among the patients with scars due to previous surgery.