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

Abstract

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.