Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2022; 14(8): 821-832
Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.821
Efficacy of staple line reinforcement by barbed suture for preventing anastomotic leakage in laparoscopic rectal cancer surgery
Bo Ban, An Shang, Jian Shi
Bo Ban, An Shang, Jian Shi, Department of General Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Author contributions: Ban B designed the research and wrote the manuscript; Shi J designed the research and supervised the manuscript; Shang A performed the research and contributed to the statistical analysis.
Supported by Science and Technology Development Project of Jilin Province, China, No. 2020SCZT079.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Second Hospital of Jilin University.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Shi, MD, PhD, Associate Chief Physician, Associate Professor, Department of General Surgery, The Second Hospital of Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun 130041, Jilin Province, China. 383888697@qq.com
Received: April 22, 2022
Peer-review started: April 22, 2022
First decision: June 19, 2022
Revised: June 28, 2022
Accepted: July 26, 2022
Article in press: July 26, 2022
Published online: August 27, 2022
Abstract
BACKGROUND

Anastomotic leakage (AL) is a severe complication in rectal cancer surgery. Various methods, including intracorporeal reinforcing suturing, have been used to reduce the incidence of AL. However, little is known about the efficacy of staple-line reinforcement by barbed suture for preventing AL.

AIM

To evaluate the efficacy of staple-line reinforcement using barbed suture for preventing AL in laparoscopic surgery for rectal cancer.

METHODS

We retrospectively reviewed the clinical datum of 319 patients undergoing laparoscopic low anterior resection combined with double stapling technique between May 1, 2017 and January 31, 2021. All surgeries were performed by the same surgical team specializing in colorectal surgery. Patients were divided into two groups depending on whether they received reinforcing sutures. Patients’ baseline characteristics did not show any significant difference between the two groups. We analyzed patient-, tumor-, as well as surgery-related variables using univariate and multivariate logistic analyses.

RESULTS

There were 168 patients in the reinforcing suture group and 151 patients in the non-reinforcing suture group. AL occurred in 25 cases (7.8%). Its incidence was significantly higher in the non-reinforcing suture group than in the reinforcing suture group (4.8% vs 11.3%, P = 0.031). The multivariate analyses demonstrated that the tumor site, tumor size and presence of staple-line reinforcement were independent risk factors for AL. We divided these patients into two risk groups based on the combination of tumor site and tumor size. Patients without any risk factor were assigned to the low-risk group (n = 177), whereas those having one or two risk factors were assigned to the high-risk group (n = 142). In the high-risk group, the AL incidence considerably decreased in the reinforcing suture group compared with that in the non-reinforcing suture group (P = 0.038). Nonetheless, no significant difference was found in the low-risk group between the two groups.

CONCLUSION

Staple-line reinforcement by barbed suture may decrease the incidence of AL. A large-scale prospective randomized controlled trial is needed for evaluating the efficacy of staple-line reinforcement for preventing AL.

Keywords: Reinforcing suture, Anastomotic leakage, Laparoscope, Rectal cancer, Double-stapling technique, Barbed suture

Core Tip: Double stapling technique (DST) has been extensively applied in rectal surgery. However, the drawbacks of DST cannot be ignored, particularly because the linear cutter application as the distal rectum incision is not completely matched with a circular incision in the proximal intestinal tract. This leads to crossing at least two staple lines, which is referred as the “dog ear” structure. Some studies have reported that such intersection induced the vulnerable area causing anastomotic leakage (AL). This study was aimed to investigate the efficacy of reinforcing anastomosis with barbed suture in preventing AL after laparoscopic DST, and evaluate its feasibility and safety.