To explore the safety and feasibly of staple-free hand-sewn laparoscopic colonic anastomosis in the totally laparoscopic left hemicolectomy.

From Apr. 2020 to Apr. 2022, in the Department of Gastrointestinal Surgery, Inner Mongolia Autonomous Region People's Hospital, patients who underwent total laparoscopic left colectomy with staple-free hand-sewn and total laparoscopic or laparoscopic-assisted left colectomy with stapler were retrospectively analyzed. According to the method of digestive reconstruction , a total of 77 patients with left colon cancer who met the inclusion criteria were divided into two groups: staple-free hand-sewn laparoscopic colonic anastomosis group (35 cases) and staple anastomosis (Overlap, end-to-end anastomosis) group (42 cases). The operation time, anastomotic complications, abdominal infection and postoperative recovery of the two types of digestive reconstruction were statistically analyzed.

No significant differences were founded in gender, age, BMI, ASA grade, tumor location, TNM stage, preoperative diabetes mellitus and preoperative imcomplete colon obstruction between the two groups (P>0.05). R0 resection was performed in both groups, none required conversion to open surgery. Moreover, there were statistically significant differences in digestive reconstruction time and auxiliary incision between the two groups.The reconstruction time of staple-free hand-sewn group was remarkably longer than staple anastomosis group[(33.7±5.0)min vs(27.1±4.9)min, P<0.001], The length of auxiliary incision of staple-free hand-sewn group was shorter than that of staple anastomosis group[(5.6±0.84)cm vs(7.7±1.11)cm, P<0.001]. In addition, there were no statistically significant differences in the incidence of overall complications, anastomotic bleeding, anastomotic leakage, anastomotic stenosis, and abdominal infection between the two groups(P>0.05). There was also no significant difference in the first flatus time and hospital stay(P>0.05). The complications of the two groups were cured by non-operative treatment. No reoperation and death cases occurred.

The technique of staple-free hand-sewn anastomosis is simple, safe and feasible in total laparoscopic left colectomy , it can be used as a supplement to staple anastomosis, but it needs to be performed by experienced laparoscopic surgeons.