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©The Author(s) 2025.
World J Gastrointest Surg. May 27, 2025; 17(5): 103758
Published online May 27, 2025. doi: 10.4240/wjgs.v17.i5.103758
Published online May 27, 2025. doi: 10.4240/wjgs.v17.i5.103758
Table 1 The outcomes in the included studies, n (%)
| Ref. | Outcome of interest | Length of the operation, minutes | Intraoperative blood loss, mL | Length of hospital stay, days | Anal exhaust time, days | Anastomotic bleeding | Anastomotic leakage | Grading of anastomotic leakage, A/B/C | Deaths related to AL | Anastomotic stricture | Intestinal obstruction | Infection | Reoperation |
| Baek et al[21] | Experimental (n = 47) | 198.3 ± 75.7 | 174.5 ± 348.0 | 11.0 ± 5.6 | 1.5 ± 0.9 | N/A | 3 (6.4) | N/A | NA | NA | NA | NA | 2 (4.3) |
| Control (n = 63) | 212.1 ± 65.0 | 188.4 ± 301.5 | 9.8 ± 6.7 | 1.5 ± 1.2 | NA | 5 (7.9) | NA | NA | NA | NA | NA | 2 (3.2) | |
| Maeda et al[22] | Experimental (n = 91) | NA | NA | NA | NA | NA | 3 (3.3) | NA | 0 (0) | NA | NA | NA | NA |
| Control (n = 110) | NA | NA | NA | NA | NA | 15 (13.6) | NA | 0 (0) | NA | NA | NA | NA | |
| He et al[23] | Experimental (n = 145) | NA | NA | NA | NA | NA | 5 (3.4) | NA | NA | NA | NA | NA | NA |
| Control (n = 146) | NA | NA | NA | NA | NA | 17 (11.6) | NA | NA | NA | NA | NA | NA | |
| Lin et al[24] | Experimental (n = 142) | 147.5 ± 35.05 | 100 ± 73.96 | 7.5 ± 3.18 | 2.5 ± 0.8 | NA | 4 (2.82) | 0/2/2 | NA | 0 (0) | NA | NA | NA |
| Control (n = 150) | 130 ± 32.07 | 100 ± 75.01 | 8 ± 4.12 | 3 ± 0.8 | NA | 15 (10.0) | 0/13/2 | NA | 0 (0) | NA | NA | NA | |
| Ban et al[25] | Experimental (n = 168) | 150.4 ± 25.1 | 60.5 ± 43.9 | NA | NA | NA | 8 (4.8) | 3/3/2 | NA | 12 (7.1) | 25 (14.9) | NA | 2 (1.2) |
| Control (n = 151) | 146.6 ± 20.2 | 58.2 ± 46.3 | NA | NA | NA | 17 (11.3) | 2/2/13 | NA | 17 (13.1) | 17 (11.3) | NA | 13 (8.6) | |
| Zhang et al[26] | Experimental (n = 198) | 109.04 ± 24.09 | 56.46 ± 8.32 | 6.61 ± 0.78 | NA | 0 (0) | 4 (2.0) | NA | 0 (0) | NA | 2 (1.0) | 1 (0.5) | NA |
| Control (n = 205) | 100.33 ± 28.91 | 56.46 ± 8.32 | 7.34 ± 1.95 | NA | 1 (0.5) | 19 (9.3) | NA | 0 (0) | NA | 1 (0.5) | 1 (0.5) | NA | |
| Hashida et al[27] | Experimental (n = 72) | NA | NA | NA | NA | NA | 1 (1.4) | NA | NA | NA | NA | NA | NA |
| Control (n = 81) | NA | NA | NA | NA | NA | 10 (12.3) | NA | NA | NA | NA | NA | NA | |
| Yi et al[28] | Experimental (n = 99) | 196.41 ± 76.71 | 72.72 ± 27.87 | 11.52 ± 3.73 | 2.75 ± 1.11 | NA | 2 (2.0) | NA | NA | NA | 3 (3.0) | 1 (1.0) | NA |
| Control (n = 146) | 182.39 ± 49.10 | 77.21 ± 49.52 | 13.79 ± 5.91 | 2.86 ± 1.28 | NA | 12 (8.2) | NA | NA | NA | 3 (2.0) | 0 (0) | NA | |
| Jin et al[29] | Experimental (n = 123) | 124.66 ± 25.27 | 48.77 ± 18.87 | 8.11 ± 2.10 | 2.63 ± 0.77 | NA | 4 (3.25) | NA | NA | NA | 2 (1.62) | 2 (1.62) | NA |
| Control (n = 135) | 116.73 ± 38.07 | 52.15 ± 22.26 | 10.87 ± 4.66 | 2.84 ± 0.58 | NA | 19 (14.07) | NA | NA | NA | 6 (4.44) | 10 (7.41) | NA | |
| Yang et al[30] | Experimental (n = 38) | 160.23 ± 3.85 | 114.90 ± 9.85 | 8.12 ± 0.56 | 3.15 ± 0.09 | NA | 1 (2.63) | NA | NA | NA | 1 (2.63) | 0 (0) | NA |
| Control (n = 38) | 128.95 ± 2.46 | 119.54 ± 6.27 | 8.06 ± 0.51 | 3.17 ± 0.07 | NA | 6 (15.79) | NA | NA | NA | 0 (0) | 1 (2.63) | NA | |
| Zhang et al[31] | Experimental (n = 60) | 158.62 ± 30.17 | 54.74 ± 10.48 | 6.84 ± 1.56 | 1.89 ± 0.55 | NA | 2 (3.33) | 2/0/0 | NA | NA | NA | NA | NA |
| Control (n = 60) | 150.02 ± 28.95 | 56.81 ± 9.96 | 7.69 ± 2.03 | 2.32 ± 0.64 | NA | 9 (15) | 1/7/1 | NA | NA | NA | NA | NA | |
| Zhang et al[32] | Experimental (n = 26) | 143.4 ± 2.5 | 91.4 ± 7.9 | NA | 3.3 ± 0.1 | 2 (7.7) | 0 (0) | NA | NA | 7 (26.9) | NA | 0 (0) | NA |
| Control (n = 32) | 118.4 ± 2.0 | 77.5 ± 6.3 | NA | 3.2 ± 0.1 | 4 (12.5) | 6 (18.8) | NA | NA | 9 (28.1) | NA | 4 (12.5) | NA | |
| Chen et al[33] | Experimental (n = 56) | 211 ± 91 | 119 ± 38 | 10.1 ± 3.2 | 2.9 ± 0.7 | 1 (1.8) | 1 (1.8) | NA | 0 (0) | NA | NA | NA | 0 (0) |
| Control (n = 64) | 174 ± 57 | 121 ± 46 | 10.7 ± 3.1 | 3.1 ± 0.7 | 3 (4.7) | 8 (12.5) | NA | 0 (0) | NA | NA | NA | 6 (9.4) | |
| Luo et al[34] | Experimental (n = 86) | 160.2 ± 3.8 | 127 ± 9 | 8.1 ± 0.5 | 3.02 ± 0.09 | NA | 2 (2.3) | NA | NA | NA | 4 (4.7) | 6 (7) | NA |
| Control (n = 129) | 128.9 ± 2.4 | 114 ± 6 | 8 ± 0.5 | 3.18 ± 0.07 | NA | 13 (10.1) | NA | NA | NA | 8 (6.2) | 8 (6.2) | NA | |
| Wu et al[35] | Experimental (n = 84) | 227.73 ± 91.2 | 58.44 ± 46.18 | NA | 3.61 ± 0.76 | NA | 5 (6) | NA | NA | NA | NA | NA | NA |
| Control (n = 170) | 203.91 ± 61.61 | 52.91 ± 64.5 | NA | 3.72 ± 0.91 | NA | 11 (6.5) | NA | NA | NA | NA | NA | NA | |
| Liu et al[36] | Experimental (n = 63) | NA | NA | NA | NA | NA | 2 (3.2) | 0/2/0 | 0 (0) | 0 (0) | NA | NA | 0 (0) |
| Control (n = 68) | NA | NA | NA | NA | NA | 9 (13.2) | 0/4/5 | 1 (1.5) | 2 (2.9) | NA | NA | 5 (7.4) | |
| Liu et al[37] | Experimental (n = 53) | 180.1 ± 12.9 | 85.9 ± 24.3 | 4.8 ± 1.1 | 1.19 ± 0.28 | 0 (0) | 0 (0) | NA | NA | NA | NA | 0 (0) | 0 (0) |
| Control (n = 44) | 179.8 ± 11.2 | 78.2 ± 29.1 | 5.2 ± 1.4 | 1.19 ± 0.30 | 1 (2.3) | 3 (6.8) | NA | NA | NA | NA | 1 (2.3) | 2 (4.5) | |
| Liu et al[38] | Continuous suture (n = 43) | 103.9 ± 30.3 | 86.0 ± 59.9 | 8.17 ± 1.52 | 2.29 ± 0.64 | 0 (0) | 2 (4.7) | 0/1/1 | NA | NA | NA | 0 (0) | 1 (2.3) |
| Interrupted suture (n = 42) | 115.1 ± 41.2 | 80.2 ± 59.9 | 8.15 ± 1.69 | 2.22 ± 0.69 | 0 (0) | 2 (4.8) | 0/2/0 | NA | NA | NA | 1 (2.4) | 0 (0) | |
| Control (n = 42) | 103.8 ± 26.2 | 97.0 ± 47.9 | 12.13 ± 1.57 | 2.50 ± 0.94 | 1 (2.4) | 7 (16.7) | 1/3/3 | NA | NA | NA | 0 (0) | 3 (7.1) | |
| Xing et al[39] | Experimental (n = 30) | 140.05 ± 2.51 | 91.43 ± 7.9 | NA | 3.33 ± 0.50 | NA | 1 (3.3) | NA | NA | NA | NA | NA | NA |
| Control (n = 30) | 119.4 ± 2.49 | 88.93 ± 6.41 | NA | 3.27 ± 0.45 | NA | 5 (16.7) | NA | NA | NA | NA | NA | NA | |
| Zheng et al[40] | Experimental (n = 113) | NA | NA | 8.11 ± 2.10 | 2.63 ± 0.77 | NA | 5 (4.42) | NA | NA | NA | 2(1.77) | 3(2.65) | NA |
| Control (n = 125) | NA | NA | 10.87 ± 4.66 | 2.84 ± 0.58 | NA | 16 (12.8) | NA | NA | NA | 10(8) | 6(4.8) | NA |
Table 2 The Newcastle-Ottawa scale for assessing the quality of included studies
| Ref. | Is the case definition adequate | Representativeness of the cases | Selection of Controls | Definition of Controls | Comparability of cases and controls on the basis of the design or analysis | Ascertainment of exposure | Same method of ascertainment for cases and controls | Non-response rate | Quality assessment score |
| Baek SJ et al[21] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | |
| Maeda K et al[22] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 8 |
| Lin et al[24] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 8 |
| Ban et al[25] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 8 |
| Zhang et al[26] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 8 |
| Hashida et al[27] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | |
| Yi et al[28] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 9 |
| Jin et al[29] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | |
| Zhang et al[32] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 9 |
| Chen et al[33] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | |
| Luo et al[34] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 9 |
| Wu et al[35] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | |
| Liu et al[36] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | |
| Liu et al[37] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 8 |
| Liu D et al[38] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | |
| Zheng et al[40] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 8 |
Table 3 The pooled outcomes
| Outcomes of interest | Number of studies | Number of patients | MD or OR (95%CI) | P value | I2, % |
| Primary outcome | |||||
| Anastomotic leakage | 20 | 3726 | 0.26 (0.19, 0.35) | < 0.001 | 0 |
| Secondary outcome | |||||
| Length of the operation | 15 | 2712 | 15.25 (10.71, 19.80) | < 0.001 | 97 |
| Intraoperative blood loss | 15 | 2712 | 2.04 (-2.35, 6.42) | 0.36 | 91 |
| Length of hospital stay | 12 | 2259 | -1.17 (-1.78, -0.57) | < 0.001 | 95 |
| Anal exhaust time | 14 | 2228 | -0.13 (-0.22, -0.05) | 0.002 | 91 |
| Anastomotic bleeding | 5 | 763 | 0.41 (0.13, 1.25) | 0.12 | 0 |
| Anastomotic stricture | 3 | 508 | 0.65 (0.35, 1.21) | 0.17 | 0 |
| Intestinal obstruction | 7 | 1754 | 0.91 (0.58, 1.42) | 0.68 | 23 |
| Infection | 8 | 1590 | 0.54 (0.29, 1.00) | 0.05 | 0 |
| Reoperation | 6 | 862 | 0.19 (0.08, 0.45) | < 0.001 | 0 |
Table 4 Results of subgroup analysis of studies - length of the operation
| Study characteristics | Number of studies | Number of patients | OR (95%CI) | I2, % | P value |
| Total | 20 | 3726 | 15.25 (10.71, 19.80) | 97 | < 0.00001 |
| Study design | |||||
| RCT | 4 | 547 | 21.59 (12.37, 30.80) | 97 | 0.13 |
| CCS | 16 | 3179 | 13.02 (6.76, 19.28) | 98 | |
| Reinforced anastomosis method | |||||
| Trans-anal reinforcing | 5 | 410 | 12.01 (5.20, 18.82) | 97 | 0.25 |
| Laparoscopic reinforcing | 15 | 3316 | 17.30 (11.25, 23.35) | 96 | |
| Reinforcing suture | |||||
| Interrupted suture | 6 | 959 | 2.58 (-7.02, 12.17) | 28 | 0.006 |
| Continuous suture | 13 | 2473 | 17.87 (12.88, 22.86) | 98 | |
| Prophylactic ileostomy | |||||
| Yes | 3 | 452 | 1.95 (-8.84, 12.74) | 42 | 0.008 |
| No | 17 | 3274 | 17.69 (13.23, 22.14) | 97 |
Table 5 Results of subgroup analysis of studies - intraoperative blood loss
| Study characteristics | Number of studies | Number of patients | OR (95%CI) | I2, % | P value |
| Total | 20 | 3726 | 2.04 (-2.35, 6.42) | 91 | 0.36 |
| Study design | |||||
| RCT | 4 | 547 | -1.39 (-5.48, 2.70) | 73 | 0.19 |
| CCS | 16 | 3179 | 3.19 (-2.39, 8.77) | 91 | |
| Reinforced anastomosis method | |||||
| Trans-anal reinforcing | 5 | 410 | 6.13 (-2.21, 14.48) | 81 | 0.26 |
| Laparoscopic reinforcing | 15 | 3316 | 0.50 (-4.77, 5.78) | 93 | |
| Reinforcing suture | |||||
| Interrupted suture | 6 | 959 | -2.30 (-5.91, 1.31) | 0 | 0.06 |
| Continuous suture | 13 | 2473 | 3.88 (-1.41, 9.17) | 94 | |
| Prophylactic ileostomy | |||||
| Yes | 3 | 452 | 1.15 (-8.41, 10.72) | 27 | 0.86 |
| No | 17 | 3274 | 2.14 (-2.62, 6.90) | 93 |
Table 6 Results of subgroup analysis of studies - length of hospital stay
| Study characteristics | Number of studies | Number of patients | OR (95%CI) | I2, % | P value |
| Total | 20 | 3726 | -1.17 (-1.78, -0.57) | 95 | 0.00002 |
| Study design | |||||
| RCT | 4 | 547 | -0.34 (-1.23, 0.54) | 85 | 0.10 |
| CCS | 16 | 3179 | -1.35 (-2.17, -0.53) | 96 | |
| Reinforced anastomosis method | |||||
| Trans-anal reinforcing | 5 | 410 | -1.19 (-4.09, 1.72) | 97 | 0.91 |
| Laparoscopic reinforcing | 15 | 3316 | -1.02 (-1.55, -0.49) | 93 | |
| Reinforcing suture | |||||
| Interrupted suture | 6 | 959 | -1.37 (-4.03, 1.28) | 96 | 0.64 |
| Continuous suture | 13 | 2473 | -0.73 (-1.22, -0.24) | 92 | |
| Prophylactic ileostomy | |||||
| Yes | 3 | 452 | -0.69 (-2.27, 0.88) | 81 | 0.50 |
| No | 17 | 3274 | -1.29 (-1.99, -0.59) | 97 |
Table 7 Results of subgroup analysis of studies - anal exhaust time
| Study characteristics | Number of studies | Number of patients | OR (95%CI) | I2, % | P value |
| Total | 20 | 3726 | -0.13 (-0.22, -0.05) | 91 | 0.002 |
| Study design | |||||
| RCT | 4 | 547 | -0.12 (-0.38, 0.13) | 86 | 0.90 |
| CCS | 16 | 3179 | -0.14 (-0.25, -0.03) | 90 | |
| Reinforced anastomosis method | |||||
| Trans-anal reinforcing | 5 | 410 | 0.05 (-0.02, 0.13) | 25 | < 0.0001 |
| Laparoscopic reinforcing | 15 | 3316 | -0.20 (-0.29, -0.11) | 88 | |
| Reinforcing suture | |||||
| Interrupted suture | 6 | 959 | -0.26 (-0.51, -0.01) | 49 | 0.24 |
| Continuous suture | 13 | 2473 | -0.10 (-0.19, 0.00) | 94 | |
| Prophylactic ileostomy | |||||
| Yes | 3 | 452 | -0.01 (-0.12, 0.09) | 0 | 0.05 |
| No | 17 | 3274 | -0.15 (-0.25, -0.06) | 93 |
- Citation: Zhuang ZX, Zhang Y, Yang XY, Wang ZQ, Deng XB, Zhang MM. Efficacy of reinforcing sutures in preventing anastomotic leakage after surgery for rectal cancer: A systematic review and metaanalysis. World J Gastrointest Surg 2025; 17(5): 103758
- URL: https://www.wjgnet.com/1948-9366/full/v17/i5/103758.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v17.i5.103758