Intracorporeal ileocolic anastomosis as an independent protective factor for persistent postoperative ileus in visceral obesity patients: a propensity score matching analysis

Abstract

Abstract Purpose: The primary objective of this study was to compare short-term outcomes between Intracorporeal ileocolic anastomosis (IIA) and extracorporeal ileocolic anastomosis (EIA) after laparoscopic right hemicolectomy in patients with visceral obesity. The secondary objective was to identify risk factors associated with persistent postoperative ileus (PPOI). Methods: This single-center retrospective study analyzed patients with visceral obesity who underwent laparoscopic right hemicolectomy for malignancybetween January 2020 and June 2023. Patients were categorized into IIA and EIA groups based on the type of anastomosis, and a 1:1 propensity score-matched analysis was performed. Results: A total of 129 patients were initially included in this study, with 45 patients in each group following propensity score matching. The IIA group had significantly longer anastomosis times (p<0.001), shorter incision length (p<0.001), and shorter length of stay (p=0.003) than the EIA group. Meanwhile, the IIA group showed a shorter time to first flatus (p=0.044) and quicker tolerance of a solid diet (p=0.030). On multivariate analysis, postoperative use of opioid analgesic is an independent risk factor for persistent postoperative ileus (PPOI) (OR: 3.672 95% CI 1.108-12.017, p=0.033), while IIA is an independent protective factor (OR: 0.246 95% CI 0.065-0.921, p=0.037). Conclusions: IIA remains a safe and feasible option for patients with VO. It is also associated with a quicker recovery of bowel function and shorter length of stay when compared to EIA. Additionally, IIA is an independent protective factor for PPOI.