Objective ·To explore the clinical effects of intra-abdominal anastomosis in laparoscopic right hemicolectomy. Methods ·Clinical data were collected from 92 patients diagnosed with right-sided colon cancer who underwent laparoscopic right hemicolectomy at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, from January 2020 and February 2024. The patients were divided into an intra-abdominal anastomosis group and an extra-abdominal anastomosis group according to the intraoperative anastomosis method. Perioperative general data, intraoperative conditions, postoperative recovery, and short-term complications within 30 d after surgery were collected and compared between the two groups. Results ·After propensity score matching, 64 well-matched patients were obtained, with 32 cases in the intra-abdominal anastomosis group and 32 cases in the extra-abdominal anastomosis group. The intraoperative blood loss in the intra-abdominal anastomosis group was significantly lower than that in the extra-abdominal anastomosis group (P<0.001), and the length of the auxiliary incision was also shorter (P<0.001). Patients in the intra-abdominal anastomosis group had shorter time to first flatus (P=0.012) and time to first defecation (P=0.003), as well as lower postoperative pain scores (P<0.001). The overall incidence of short-term complications and the incidence of surgical site infection in the intra-abdominal anastomosis group were 21.88% and 6.25%, respectively, which were significantly lower than those in the extra-abdominal anastomosis group (37.50% and 28.13%, respectively; P=0.041 and P=0.032). Within 30 d postoperatively, the intra-abdominal anastomosis group had significantly lower severe complication (Clavien-Dindo≥grade Ⅱ) rate compared with the extra-abdominal anastomosis group (12.50% vs 31.25%, P=0.045). Conclusion ·Compared with extra-abdominal anastomosis in laparoscopic right hemicolectomy, intra-abdominal anastomosis demonstrates significant advantages in terms of reduced intraoperative blood loss, less surgical trauma, faster recovery of intestinal function, lower postoperative pain, and a lower incidence of short-term complications.