Author response to: Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy; earlier recovery, less complications, and more

Editor We appreciate Emile's interest in our recently published paper and would like to add some comments. We welcome the fact that social media highlighted our results and led to discussion and correspondence on our paper just a few hours after its publication online. Emile's comments questioned the main outcome of our paper, selection of a process or clinical outcome versus a morbidity parameter. Intracorporeal anastomosis (IA) for laparoscopic right colectomy is not merely a technical option in anastomosis formation, it is a different surgical strategy. The main parameter measured should therefore be related to clinical outcome (pain, bowel recovery, length of stay). Obviously, morbidity is of paramount importance, but as a secondary, not primary outcome. Anastomotic leak rates after IA versus extracorporeal anastomosis (EA) seem to be similar, increasing the number of patients needed per arm to detect a significant difference. The final meta-analysis (n = 4450) described an anastomotic leak rate of 2·9 per cent for the EA group and 1·3 per cent for the IA group1. The Colon DX Italian Group (n = 1225) reported an AL of 1·6 per cent in the EA group and 2·2 per cent in the IA group2. As with the previous data, the sample size required to perform an RCT would be so large that it would make the study almost impossible.