Intracorporeal reinforcement with barbed suture is associated with low anastomotic leakage rates after laparoscopic low anterior resection for rectal cancer: a retrospective study

Abstract

Background Anastomotic leakage (AL) is one of most severe postoperative complications following low anterior resection (LAR) for rectal cancer, and has an adverse impact on postoperative recovery. The occurence of AL is associated with several factors, while few studies explored the role of intracorporeal barbed suture reinforcement in it. Methods Consecutive cases underwent laparoscopic LAR for rectal cancer from Mar. 2018 to Feb. 2021 in our center were retrospectively collected. Cases were classified into the intracorporeal barbed suture reinforcement group and the control group according to whether performing intracorporeal reinforcement with barbed suture, and AL incidences were compared between two groups. Propensity score matching (PSM) was then performed based on identified risk factors to reduce biases from covariates between two groups. AL incidences in the matched cohort were compared. Results A total of 292 cases entered into the study, and AL incidences were significantly lower in the intracorporeal barbed suture reinforcement group compared with the control group (10.00% vs 2.82%, P = 0.024). Sex, BMI, preoperative adjuvant chemoradiotherapy and anastomotic level were chose for PSM analyses based on previous studies. In the matched cohort, the AL incidences were still significantly lower in the intracorporeal barbed suture reinforcement group (10.57% vs 2.44%, SD = 0.334). Conclusions Intracorporeal barbed suture reinforcement is associated with low AL incidences after laparoscopic LAR for rectal cancer, which is a potential procedure for reducing AL and worthy of application clinically.

Effectiveness of anastomotic reinforcement sutures in reducing anastomotic leakage risk after laparoscopic rectal cancer surgery: a pooled and integration analysis

“…The current studies have confirmed that tumor size, distance from the tumor to the anal verge, and the use of reinforcement sutures to the anastomosis are independent risk factors for symptomatic AL (29). Lin et al (11) conducted a retrospective study of 292 patients undergoing laparoscopic low anterior resection for rectal cancer. They found that the use of barbed sutures for anastomotic reinforcement was associated with a low incidence of AL.…”

“…Similarly, Senagore et al (10) have concluded that reinforcement of colorectal anastomoses with bioabsorbable material did not affect the incidence of anastomotic leaks but may reduce anastomotic strictures. However, Lin et al (11), in a study of anastomotic reinforcement with barbed sutures during laparoscopic low anterior resection of rectal cancer, found that the incidence of AL was 10% in the control group and 2.82% in the suture-reinforced group, suggesting that reinforcement of the anastomotic "dog's ear" area with sutures is associated with a low incidence of AL. Similarly, Ban et al (12) have demonstrated that reinforcement of the anastomosis with barbed sutures after laparoscopic rectal cancer resection significantly reduced the incidence of AL.…”

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“…In addition, 27 full-text were excluded, 19 studies were excluded because they were single-arm studies, and eight studies did not provide data information because they were clinical guidelines. Fourteen studies met the inclusion criteria for this analysis (12 retrospective studies (11,12,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) versus two randomized controlled studies (26,27)). A total of 14 studies (11,12,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) with 2,452 patients (reinforced suture group, n = 1196, and non-reinforced suture group, n = 1,256) were included.…”

“…Fourteen studies met the inclusion criteria for this analysis (12 retrospective studies (11,12,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) versus two randomized controlled studies (26,27)). A total of 14 studies (11,12,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) with 2,452 patients (reinforced suture group, n = 1196, and non-reinforced suture group, n = 1,256) were included. All patients included in the study underwent rectal resection.…”

“…Fourteen studies (11,12,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), which included 2,452 participants, were reported with data on AL after laparoscopic surgery for rectal resection. Pooled analysis showed that reinforced sutures to the anastomosis significantly reduced the risk of AL in patients undergoing laparoscopic surgery for rectal resection (OR = 0.26; 95% CI, 0.18-0.37; P < 0.00001; I 2 = 0%; Figure 3).…”