Background and Objectives: Anastomotic leak after left-sided colectomy has not declined despite refinements in technique and patient selection, prompting interest in whether local reinforcement might influence the clinical course of leaks that occur rather than their occurrence. We describe the feasibility and safety of Hemopatch serosal reinforcement of stapled colocolic anastomoses in elective left colectomy, and the distribution of leak grades observed under two reinforcement practices in routine use. Materials and Methods: A retrospective single-centre cohort of consecutive elective left colectomies was observed (January 2013–December 2024). Reinforcement technique followed the operating surgeon’s routine practice and was therefore completely confounded with surgeon and department; the study was not designed to isolate a device effect, and no causal or comparative-effectiveness inference is drawn. Leaks were graded by the ISREC classification. Balance was quantified with standardised mean differences (SMD) and proportions with exact 95% confidence intervals; a penalised (Firth) logistic model is reported as exploratory. Results: Ninety-four patients were analysed (28 Hemopatch, 66 s-line suture). Reinforcement was applied as intended in all 28 Hemopatch cases (100%, 95% CI 87.7–100). The Hemopatch group was older (median 76.5 vs. 68 years; SMD 0.89), with further imbalance in both directions. Anastomotic leak occurred in 14.3% (95% CI 4.0–32.7) versus 13.6% (6.4–24.3); the exploratory model was uninformative (OR 1.20, 95% CI 0.32–4.48). Leak grades were distributed differently, with no Hemopatch leak requiring reoperation (0%, 95% CI 0–12.3) versus four (6.1%, 1.7–14.8) and radiologically detected leaks more frequent with Hemopatch; all intervals overlapped substantially. Length of stay (median 9 vs. 6.5 days), readmission (35.7% vs. 11.3%) and two reoperative small-bowel obstructions occurred in the Hemopatch group. Conclusions: Hemopatch serosal reinforcement was technically feasible. Leak occurrence was similar between practices; leak grades differed in distribution, with reoperation for leak absent in the Hemopatch group. As reinforcement was confounded with surgeon and department, these differences describe two practices rather than a device effect. Longer stay and higher readmission require prospective safety capture; two adhesive obstructions occurred in the Hemopatch group, with operative findings in both remote from the reinforcement site. Prospective cluster-adjusted evaluation is required before any efficacy claim.

Background: Postoperative ventral hernia (POVH) remains a significant complication following laparoscopic colectomy despite minimally invasive approaches. Extraction site selection may influence POVH incidence, yet optimal location remains controversial. Methods: This retrospective cohort study analyzed 550 patients undergoing elective laparoscopic right colectomy (2009–2024) at a single center. After exclusions for anastomotic leak and loss to follow-up, 266 patients were propensity-matched 1:1 comparing paramedian (n = 133) versus midline (n = 133) extraction sites. The primary outcome was POVH incidence at 36 months. Secondary outcomes included risk factor identification using multivariate logistic regression and Firth penalized methods. Results: POVH occurred in 3/133 (2.3%) paramedian versus 15/133 (11.3%) midline patients (p = 0.007). Multivariate analysis identified midline extraction (aOR 30.3, 95% CI: 3.34–969, p < 0.001), chronic cough (aOR 25.6, 95% CI: 3.56–287, p = 0.001), and constipation (aOR 10.1, 95% CI: 1.60–70.7, p = 0.015) as independent POVH predictors. Patient comorbidities showed stronger associations than surgical factors in univariate analysis. The number needed to treat with paramedian extraction to prevent one POVH was 11.1. Conclusions: Paramedian extraction sites significantly reduce POVH incidence compared to midline approaches in laparoscopic right colectomy. The identification of modifiable physiological risk factors, particularly conditions causing increased intra-abdominal pressure (chronic cough, constipation), suggests that comprehensive perioperative optimization targeting these specific factors may further reduce POVH risk.