Efficacy of reinforcing sutures in preventing anastomotic leakage after surgery for rectal cancer: A systematic review and metaanalysis

Abstract

BACKGROUND

Anastomotic leakage (AL) is a challenging complication following rectal cancer surgery, often leading to increased morbidity and healthcare costs. The use of reinforcement sutures is expected to reduce the rate of AL, their preventive effects are controversial.

AIM

To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.

METHODS

A systematic search of major medical databases was conducted to identify studies up to June 2024. Intraoperative and postoperative outcomes were assessed; the primary outcome assessed was the incidence of AL. Pooled odds ratios (ORs) and mean differences (MDs) with a 95% confidence interval (CI) were calculated using fixed-effect or random-effect models under heterogeneity.

RESULTS

This meta-analysis incorporated 20 studies involving 3726 patients. Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group (OR: 0.26, 95%CI: 0.19-0.35, P < 0.001) than the unreinforced suture group. The reinforced suture group also exhibited a shorter hospital stay (MD: -1.17, 95%CI: -1.78 to -0.57, P < 0.001), earlier anal exhaust (MD: -0.13, 95%CI: -0.22 to -0.05, P = 0.002), longer operative time (MD: 15.25, 95%CI: 10.71-19.80, P < 0.001), lower infection rate (OR: 0.54, 95%CI: 0.29-1.00, P = 0.05) and lower reoperation rate (OR: 0.19, 95%CI: 0.08-0.45, P < 0.001).

CONCLUSION

The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence post-rectal cancer surgery. Nevertheless, these conclusions warrant verification through additional high-quality randomized controlled trials.

Keywords: Rectal cancer; Anastomotic leakage; Reinforcing suture; Meta-analysis; Systematic review

Core Tip: This extensive systematic review rigorously evaluates the effectiveness and safety of trans-anal versus intracorporeal reinforcement sutures in low anterior resection for rectal cancer, offering the most robust methodological appraisal to date. Through heterogeneity assessment, sensitivity and subgroup analyses, and publication bias evaluation, it strengthens evidence quality, addresses outcome variability, and underscores clinical implications. Results inform surgical decision-making by comparing anastomotic leakage risks, postoperative morbidity, and technical feasibility, advocating for standardized practices to optimize colorectal surgical outcomes.