Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: An Updated Systematic Review and Meta-analysis of Randomized Control Trials

Introduction Laparoscopic right hemicolectomy is the standard for treating right colon disease, yet the choice between intracorporeal and extracorporeal anastomosis remains debated. This study compares their safety and efficacy. Methods We conducted a systematic search in PubMed, Embase, Web of Science, and Cochrane Library for randomized controlled trials comparing these anastomosis techniques in laparoscopic right hemicolectomy up to June 4, 2023. The primary outcome was anastomotic leakage within 30 days. Statistical analyses used Review Manager (version 5.4.1). Results Seven RCTs involving 720 patients were included. No significant difference in anastomotic leakage was found between groups (RR 0.93, 95% CI 0.49–1.76, p=0.83). However, intracorporeal anastomosis showed lower rates of postoperative ileus (RR 0.67, 95% CI 0.45–0.99; p=0.04) and surgical site infections (RR 0.34, 95% CI 0.16–0.74; p=0.007). Patients with intracorporeal anastomosis had faster bowel function recovery (gas passage: WMD -0.39, p=0.0002; stool passage: WMD -0.53, p=0.001) and shorter hospital stays (WMD -0.46, p=0.001). Conclusion Intracorporeal anastomosis does not increase the risk of anastomotic leakage compared to extracorporeal anastomosis and promotes faster bowel recovery. It is a safe and effective option.