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Twenty-seven experts under the aegis of the French Association of Surgery (AFC) offer this reference system with formalized recommendations concerning the performance of right colectomy by robotic approach (RRC). For RRC, experts suggest patient installation in the so-called "classic" or "suprapubic" setup. For patients undergoing right colectomy for a benign pathology or cancer, RRC provides no significant benefit in terms of intra-operative blood loss, intra-operative complications or conversion rate to laparotomy compared to laparoscopy. At the same time, RRC is associated with significantly longer operating times. Data from the literature are insufficient to define whether the robot facilitates the performance of an intra-abdominal anastomosis, but the robotic approach is more frequently associated with an intra-abdominal anastomosis than the laparoscopic approach. Experts also suggest that RRC offers a benefit in terms of post-operative morbidity compared to right colectomy by laparotomy. No benefit is retained in terms of mortality, duration of hospital stay, histological results, overall survival or disease-free survival in RRC performed for cancer. In addition, RRC should not be performed based on the cost/benefit ratio, since RRC is associated with significantly higher costs than laparoscopy and laparotomy. Future research in the field of RRC should consider the evaluation of patient-targeted parameters such as pain or quality of life and the technical advantages of the robot for complex procedural steps, as well as surgical and oncological results. [ABSTRACT FROM AUTHOR]

Anastomotic leak is a serious complication of colonic surgery. The aim of our study is to evaluate the impact of vascular calcifications of the celiac axis and superior mesenteric artery in patients undergoing elective right colectomy, and particularly their relationship to the risk of anastomotic leak. We performed a retrospective analysis of preoperative abdominal computerized tomography (CT) scans of patients who underwent right colectomy at the Vendean Departmental Hospital (France) between January 2011 and December 2016. We established a calcification score, which was correlated to the incidence of anastomotic leak and to the patients' American Society of Anesthesiologists (ASA) score. The charts of 250 patients were reviewed. Twenty-three patients had a postoperative anastomotic leak. A stratified analysis revealed that the risk of developing an anastomotic leak was statistically significantly increased in patients whose calcification score was equal to or greater than 3 (P < 0.05). In these patients, the risk was increased by a factor of 3.48 [odds ratio: 3.48 (1.45–8.36)]. A second stratified analysis showed that a calcification score of 2 at the level of the celiac axis takeoff was correlated with a statistically significantly increased risk of anastomotic leak (P < 0.01). There was a correlation between a calcification score ≥ 3 and an ASA score ≥ 3. A calcification score ≥ 3 correlates to an increased risk of anastomotic leak. The analysis of CT findings is simple, easy and reproducible. This calcification score should be confirmed by a prospective study. [ABSTRACT FROM AUTHOR]

Summary Background Hemicolectomy is the treatment of choice for intestinal obstruction from right colon cancer. This review compares the laparoscopic vs open access in hemicolectomy for patients with right colon cancer. Methods A systematic review and meta-analysis of clinical studies published after January 2017 was performed according to the Prisma guidelines. The study has been recorded on the Prospero register (CRD42016044108). Results Five studies were included for review. Only one anastomotic leak was reported in conventional open anastomosis group (1.9%) and none of the studies included in the meta-analysis reported re-operations during the first 30 postoperative days. The 30-day postoperative mortality did not differ between the two groups. The length of incision, blood loss, early mobilization after surgery, the 30-day postoperative overall complication rate and hospital length of stay were significantly shorter in the laparoscopic group. The difference in the duration of procedure was statistically significant in favor of the open group. The number of dissected lymph nodes, the overall survival at 5 years and time to flatus were described only in one study, without any significant difference. Finally, none of the trials reported any information concerning differences in the costs between the two techniques. Conclusions The better outcomes described in this study achieved with laparoscopy, must be interpreted with caution because of the small number of patients involved, the selection and publication bias and the low level of evidence of the analysed trials. Indeed, the advantages of a minimally invasive approach, which have been demonstrated by the present meta-analysis, should encourage the use of laparoscopy also in emergency setting. [ABSTRACT FROM AUTHOR]

Summary: The role of laparoscopy for right colectomy remains controversial – largely because of a lack of standardization of the operative procedure, including a diversity of techniques including laparoscopy-assisted cases with extra-corporeal anastomosis and totally laparoscopic procedures with intra-corporeal anastomosis. Methods: The charts of all patients who underwent right colectomy by a totally laparoscopic approach in our service since 2004 were reviewed and pre-, intra-, and postoperative data were collected. Results: Eighty-two patients underwent totally laparoscopic right colectomy; of these, 32 had a BMI greater than 20kg/m2 (39%). The mean operative duration was 113minutes. In most cases, the operative specimen was extracted through a supra-pubic Pfannenstiel incision measuring 4–6cm in length. Three cases were converted to a laparoscopy-assisted technique (in order to control the ileo-cecal vascular pedicle because of extensive nodal invasion in two cases, and to evaluate a hepatic flexure polyp in the third case). Overall morbidity was 29.3% and parietal morbidity was only 9.8%; there was no difference in morbidity between obese patients (BMI>30kg/m2) and non-obese patients (BMI<30kg/m2). The mean duration of hospitalization was 9 days and two patients developed ventral hernia in the extraction incision in long-term follow-up. Conclusion: These satisfactory results show that the totally laparoscopic approach to right colectomy is technically feasible and safe, even in obese patients. In addition, the very low rate of parietal complications is an argument in favor of this approach. [Copyright &y& Elsevier]

Summary This case report concerns a man with appendicitis following right colectomy. [ABSTRACT FROM AUTHOR]