Intracorporeal reinforcing sutures reduce anastomotic leakage in double-stapling anastomosis for laparoscopic rectal surgery.

Abstract

Introduction:In rectal surgery, double-stapled anastomosis is one of the most common techniques. However, the crossing of the staple line is considered a weakness of this method and could lead to anastomotic leakage (AL), which is one of the major complications of rectal cancer surgery. Aim: To investigate the usefulness of laparoscopic intracorporeal reinforcement suturing for preventing AL in laparoscopic rectal surgery. Material and methods: A total of 153 patients with rectal cancer underwent laparoscopic rectal resection with anastomosis using the double-stapling technique between January 2015 and December 2018. Patient characteristics, surgical data, and outcomes were recorded and retrospectively analysed. Patients who received intracorporeal reinforcing sutures (n = 72) were compared with those who did not receive the reinforcing sutures (n = 81). Results: AL was observed in 11 (7.2%) cases overall and in only 1 case in the group with intracorporeal reinforcing sutures. There were no associations between clinicopathological factors and the use of reinforcing sutures. Multivariate analysis revealed that a distance from the anal verge of less than 6.5 cm, diabetes mellitus, and the non-use of reinforcing sutures were independent risk factors for AL. Conclusions: Laparoscopic intracorporeal reinforcing sutures reduced the incidence of AL. Therefore, laparoscopic reinforcing sutures for double-stapled anastomoses seem useful for the prevention of AL.

Efficacy of reinforcing sutures for prevention of anastomotic leakage after low anterior resection for rectal cancer: A systematic review and meta‐analysis

“…The sample sizes of the studies ranged from 54 to 319 patients. There were four observational studies 11 , 18 , 19 , 20 and two randomized controlled trials, 21 , 22 which included 1128 patients. A total of 548 patients received reinforcing sutures and 580 did not.…”

“… 21 , 22 The risk of bias for the four observational studies was assessed using ROBINS‐I tool. Three studies 11 , 19 , 20 were considered to be at moderate risk of overall bias, and one study 18 was considered to be at serious risk of overall bias (Electronic Supplementary Material : Details of the risk of bias).…”

“…The technique is reinforcing sutures. While one study has found that the use of reinforcing sutures in anal preservation surgery significantly reduces the incidence of anastomotic leakage, 11 another has not. 12 Therefore, we conducted this study to summarize the efficacy of reinforcing sutures for the prevention of anastomotic leakage in patients with rectal cancer after low anterior rectal resection.…”

A longer pelvis is associated with longer operative time in transanal total mesorectal excision (TME) but not in laparoscopic TME. Results from a retrospective cohort study.

“…It was introduced to overcome the difficulties encountered during laparoscopic anterior resection (LAR), particularly for distal rectal tumors [ 2 ]. A narrow, funneling pelvic bony structure has traditionally been perceived as a challenging surgical field that impedes surgical instrument maneuvers in the transabdominal TME [ 3 ]. Compared to the abdominal approach, TaTME proved to be non-inferior in the quality of specimens and postoperative complications [ 4 , 5 ].…”

Table_1.docx

“…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.…”