Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jan;46(1):9-18.
doi: 10.15537/smj.2025.46.1.20240422.

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

Feng-Bing Wang  1 , Min-Min Song  1 , Nian-Wen Zhang  1 , Wei-Feng  1 , Bin-Liu  1 , Peng-Fei Zhang  1
Affiliations
Meta-Analysis

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

Feng-Bing Wang et al. Saudi Med J. 2025 Jan.

Abstract

Objectives: 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.

Method: 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.

Result: 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).

Conclusion: 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.

Keywords: anastomotic leakage (AL); laparoscopic surgery; rectal cancer; reinforcing sutures.

PubMed Disclaimer

Figures

Figure 1
Figure 1
- The Cochrane risk of bias assessment tool was used to evaluate the included articles’ quality. A) Risk of bias graph; B) Risk of bias summary.
Figure 1
Figure 1
- The Cochrane risk of bias assessment tool was used to evaluate the included articles’ quality. A) Risk of bias graph; B) Risk of bias summary.
Figure 2
Figure 2
- Flow diagram of study selection.
Figure 3
Figure 3
- Comparison of anastomotic leakage between laparoscopic reinforcing sutures and non-reinforcing sutures. A) Forest plot of anastomotic leakage; B) Funnel plot of anastomotic leakage.
Figure 4
Figure 4
- Forest plots comparing laparoscopic reinforcing sutures to non-reinforcing sutures. A) Forest plot of the exhaust time; B) Forest plot of hospital stay.
Figure 5
Figure 5
- Forest plots comparing laparoscopic reinforcing sutures to non-reinforcing sutures. A) Forest plot of intraoperative blood loss; B) Forest plot of the occurrence of bowel obstruction
Figure 6
Figure 6
- Forest plot of the operation time.
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71: 209-249. - PubMed
    1. Zhang HQ, Xu L, Wang ZL, Shao Y, Chen Y, Lu YF, Fu Z. The effect of reinforcing sutures and trans-anal drainage tube on the outcome of laparoscopic resection for rectal cancer: propensity score matched analysis. Langenbecks Arch Surg 2023; 408: 289. - PubMed
    1. Benson AB, Venook AP, Al-Hawary MM, Azad N, Chen YJ, Ciombor KK, Cohen S, Cooper HS, Deming D, Garrido-Laguna I, Grem JL. Rectal cancer, version 2.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2022; 20: 1139-1167. - PubMed
    1. Tschann P, Weigl MP, Szeverinski P, Lechner D, Brock T, Rauch S, Rossner J, Eiter H, Girotti PN, Jäger T, Presl J. Are risk factors for anastomotic leakage influencing long-term oncological outcomes after low anterior resection of locally advanced rectal cancer with neoadjuvant therapy? A single-centre cohort study. Langenbecks Arch Surg 2022; 407: 2945-2957. - PubMed
    1. Yang Y, Ding F, Xu T, Pan Z, Zhuang J, Liu X, Guan G. Double-stapled anastomosis without “dog-ears” reduces the anastomotic leakage in laparoscopic anterior resection of rectal cancer: a prospective, randomized, controlled study. Frontiers in Surgery. 2023. Jan 6;9:1003854. - PMC - PubMed

Publication types

LinkOut - more resources