Effect of laparoscopic intracorporeal reinforcing sutures to prevent anastomotic leakage: A meta-analysis

To assess the effectiveness of reinforcing sutures after surgery for rectal cancer and its associated impact on postoperative recovery. Anastomotic leakage (AL) is a common and serious complication after anteriorrectal resection. It is currently unclear whether laparoscopic intracorporeal reinforcingsutures can effectively reduce the incidence of AL.

From inception to 2024, the literature search was conducted using a variety of databases, including PubMed, the Chinese biomedical literature database (CBM), Wanfang, EMBASE, the Cochrane Library, VIP, and China National Knowledge Infrastructure (CNKI), to identify relevant articles. Free-text forms were used to search the literature: "rectal cancer", "rectal neoplasms", "reinforcing sutures", and "anastomotic leakage" or AL. The search was undertaken by 2 different reviewers, who independently evaluated the studies.

Twelve retrospective studies and 4 RCTs were analyzed in all. A total of 3147 individuals were identified, with 1512 receiving reinforcing sutures and 1635 not. Patients who underwent laparoscopic surgery to get reinforcing sutures had a notably decreased occurrence of anastomotic leakage, according to our data. (OR 0.33; 95% CI 0.21-0.51, p<0.00001). It had an earlier anal exhaust time and a shorter hospitalization. The 2 different groups did not differ substantially with regard to intraoperative blood loss or the rate of postoperative intestinal obstruction. However, patients who received reinforced sutures via a laparoscopic approach cost more operative time (MD=16.77, 95% CI 11.31-22.23, p<0.00001).

The occurrence of AL can be greatly decreased through the use of a laparoscopic approach for anastomotic reinforcement, which may be a better option after radical surgery for rectal patients. However, more RCT studies with large sample sizes are needed.PROSPERO: CRD42024548847.