LAUSR

We enjoyed reading the RCT comparing intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right colectomy1. According to the authors’ conclusions, IA shows significant benefits over EA, including: earlier recovery of digestive function, less paralytic ileus, lower analgesia requirements, smaller decrease in haemoglobin and less gastrointestinal haemorrhage. No significant differences were recorded for anastomotic leak rate, wound infection rate, severity of complications (Grade III), length of hospital stay, readmission rate and oncological findings1. A single-centre, double-blinded, RCT study by Allaix et al.2 compared IA and EA techniques. Postoperative outcomes favoured IA for both bowel function recovery and pain, but with no differences in time to first oral intake, severity of complications, median length of hospital stay, 30-day morbidity rate, incisional hernia rate or median number of lymph nodes. Although not statistically significant, the anastomotic leak rate in IA was higher than in EA (8⋅6 versus 2⋅9 per cent)2. The latest meta-analysis included 23 of 25 retrospective studies (one prospective and one randomized study), 18 of 25 single-centre studies and 19 of 25 poor quality studies3. We must keep in mind that some definitions are not reported universally (conversion) or are different (anastomotic leakage)3. Heterogeneity, in addition to lack of randomization did not allow the authors to conclude that one technique had advantages over the other3. As the third randomized trial on this topic, Bollo et al.1 seem to be in line with the results of other studies, reinforcing the advantages of IA2,4.