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Purpose <p>Anastomotic leakage (AL) is a major complication of anterior resection of rectal cancer. Reinforcement sutures at the anastomotic staple line may reduce the risk of AL; however, their efficacy remains uncertain. This meta-analysis evaluated the effectiveness of staple line reinforcement in preventing AL.</p> Methods <p>A systematic review and meta-analysis were conducted following the PRISMA guidelines (PROSPERO registration; CRD42024581347). Literature published between January 2000 and August 2024 was searched. Randomized controlled trials (RCTs) and observational studies (OBSs) comparing reinforcement sutures with non-reinforcement sutures were included. The primary outcome was AL incidence, and secondary outcomes included reoperation rates, operative time, and mortality. Data were analyzed using a random-effects model.</p> Results <p>One RCT and eight OBSs were included, with a meta-analysis performed only for OBSs. Reinforcement sutures significantly reduced AL (odds ratio [OR], 0.29; 95% confidence interval [CI] 0.18–0.46; <i>p</i> &lt; 0.000001), with low heterogeneity (<i>I</i><sup>2</sup> = 0%). A subgroup analysis excluding diverting stoma (DS) creation confirmed reduced AL (OR, 0.41; 95% CI 0.27–0.62; <i>p</i> &lt; 0.0001). The reoperation rate was also lower (OR, 0.32; 95% CI 0.14–0.72; <i>p</i> = 0.006). The mortality and operative time were unaffected.</p> Conclusions <p>Reinforcement sutures can reduce the AL and reoperation rates in patients with rectal cancer undergoing stapled anastomosis. Large-scale RCTs are required to confirm the optimal benefits and long-term effects.</p>

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Reinforcement sutures for preventing anastomotic leakage following double-stapling anastomosis in rectal cancer surgery: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年7月17日

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  • Koji Tamura,
  • Takaaki Fujimoto,
  • Kinuko Nagayoshi,
  • Yusuke Mizuuchi,
  • Kyoko Hisano,
  • Kohei Horioka,
  • Koji Shindo,
  • Naoki Ikenaga,
  • Kohei Nakata,
  • Kenoki Ohuchida,
  • Masafumi Nakamura

摘要

Purpose

Anastomotic leakage (AL) is a major complication of anterior resection of rectal cancer. Reinforcement sutures at the anastomotic staple line may reduce the risk of AL; however, their efficacy remains uncertain. This meta-analysis evaluated the effectiveness of staple line reinforcement in preventing AL.

Methods

A systematic review and meta-analysis were conducted following the PRISMA guidelines (PROSPERO registration; CRD42024581347). Literature published between January 2000 and August 2024 was searched. Randomized controlled trials (RCTs) and observational studies (OBSs) comparing reinforcement sutures with non-reinforcement sutures were included. The primary outcome was AL incidence, and secondary outcomes included reoperation rates, operative time, and mortality. Data were analyzed using a random-effects model.

Results

One RCT and eight OBSs were included, with a meta-analysis performed only for OBSs. Reinforcement sutures significantly reduced AL (odds ratio [OR], 0.29; 95% confidence interval [CI] 0.18–0.46; p < 0.000001), with low heterogeneity (I2 = 0%). A subgroup analysis excluding diverting stoma (DS) creation confirmed reduced AL (OR, 0.41; 95% CI 0.27–0.62; p < 0.0001). The reoperation rate was also lower (OR, 0.32; 95% CI 0.14–0.72; p = 0.006). The mortality and operative time were unaffected.

Conclusions

Reinforcement sutures can reduce the AL and reoperation rates in patients with rectal cancer undergoing stapled anastomosis. Large-scale RCTs are required to confirm the optimal benefits and long-term effects.