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©The Author(s) 2022.
World J Gastrointest Surg. Aug 27, 2022; 14(8): 821-832
Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.821
Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.821
Table 1 Baseline characteristics of patients (n = 319)
Variables | Reinforcing sutures | P value | |
Yes, n = 168 | No, n = 151 | ||
Age (yr) | 61.8 ± 8.7 | 63.0 ± 9.7 | 0.229 |
Men/Women | 80/88 | 73/78 | 0.897 |
BMI (kg/m2) | 23.2 ± 3.6 | 22.8 ± 3.8 | 0.378 |
ASA score, n (%) | 0.948 | ||
1 | 60 (35.7) | 54 (35.8) | |
2 | 67 (39.9) | 61 (40.4) | |
3 | 41 (24.4) | 36 (23.8) | |
Tumor diameter (cm) | 4.4 ± 1.7 | 4.1 ± 1.8 | 0.178 |
Tumor site (from anal verge, cm), n (%) | 0.641 | ||
≥ 5 | 123 (73.2) | 114(75.5) | |
< 5 | 45 (26.8) | 37(24.5) | |
Depth of tumor invasion, n (%) | 0.295 | ||
T1-T2 | 33 (19.6) | 37 (24.5) | |
T3-T4 | 135 (80.4) | 114 (75.5) | |
Lymph node metastases, n (%) | 0.493 | ||
Yes | 77 (45.8) | 75 (49.7) | |
No | 91 (54.2) | 76 (50.3) | |
Diabetes mellitus, n (%) | 31 (18.5) | 22 (14.6) | 0.352 |
Hypertension, n (%) | 37 (22.0) | 25 (16.6) | 0.218 |
Heart disease, n (%) | 18 (10.7) | 11 (7.3) | 0.287 |
COPD, n (%) | 9 (5.4) | 7 (4.6) | 0.768 |
Previous abdominal surgery, n (%) | 17 (10.1) | 14 (9.3) | 0.799 |
Preoperative CEA (ng/mL), n (%) | 0.430 | ||
≥ 5 | 57 (33.9) | 45 (29.8) | |
< 5 | 111 (66.1) | 106 (70.2) | |
Preoperative hemoglobin levels (g/L), n (%) | 0.239 | ||
≥ 90 | 138 (82.1) | 116 (76.8) | |
< 90 | 30 (17.9) | 35 (23.2) | |
Preoperative serum albumin level (g/L), n (%) | 0.301 | ||
≥ 35 | 139 (82.7) | 118 (78.1) | |
< 35 | 29 (17.3) | 33 (21.9) | |
Preoperative serum CRP level (mg/L), n (%) | 0.375 | ||
≥ 10 | 28 (16.7) | 28 (20.5) | |
< 10 | 140 (83.3) | 123 (79.5) |
Table 2 Surgical outcomes and postoperative complications
Variables | Reinforcing sutures | P value | |
Yes, n = 168 | No, n = 151 | ||
Left colic artery ligation, n (%) | 0.637 | ||
Yes | 79 (47.0) | 75 (49.7) | |
No | 89 (53.0) | 76 (50.3) | |
Number of staple firings, n (%) | 0.902 | ||
≥ 3 | 16 (9.5) | 15 (9.9) | |
< 3 | 152 (90.5) | 136 (90.1) | |
Operation time (min) | 150.4 ± 25.1 | 146.6 ± 20.2 | 0.135 |
Intraoperative transfusion, n (%) | 20 (11.9) | 15 (9.9) | 0.574 |
Intraoperative blood loss (mL) | 60.5 ± 43.9 | 58.2 ± 46.3 | 0.652 |
Complications, n (%) | |||
Anastomotic leakage | 8 (4.8) | 17 (11.3) | 0.031 |
Postoperative intestinal obstruction | 25 (14.9) | 17 (11.3) | 0.339 |
Anastomosis stricture | 12 (7.1) | 17 (13.1) | 0.202 |
Postoperative defecation dysfunction, 3 mo | 31 (18.5) | 25 (16.6) | 0.657 |
Postoperative defecation dysfunction, 6 mo | 23 (13.7) | 21 (13.9) | 0.955 |
Postoperative defecation dysfunction, 12 mo | 12 (7.1) | 9 (6.0) | 0.671 |
Table 3 Anastomotic leakage related indices (n = 25)
Reinforcing sutures | P value | ||
Yes, n = 8 | No, n = 17 | ||
AL classification | 0.020 | ||
Grade A | 3 | 2 | |
Grade B | 3 | 2 | |
Grade C | 2 | 13 | |
AL time (d) | 5 (2–7) | 4 (1–7) | 0.715 |
Treatment | |||
Trans-anal lavage and drainage | 2 | 1 | 0.231 |
Peritoneal lavage and drainage | 1 | 1 | 1.000 |
Reoperation | 2 | 13 | 0.028 |
Table 4 Univariate and multivariate regression on anastomotic leakage-related factors (n = 319)
Variables | Univariate regression | Multivariate regression | ||||
OR | 95%CI | P value | OR | 95%CI | P value | |
Male gender | 1.189 | 0.523–2.705 | 0.680 | |||
Age ≥ 60 (yr) | 2.123 | 0.824–5.473 | 0.119 | |||
BMI ≥ 25 (kg/m2) | 1.115 | 0.448–2.775 | 0.814 | |||
Diabetic mellitus | 2.604 | 1.060–6.394 | 0.037 | 1.662 | 0.588–4.669 | 0.338 |
Hypertension | 1.039 | 0.374–2.888 | 0.941 | |||
Heart disease | 2.050 | 0.652–6.441 | 0.219 | |||
COPD | 1.739 | 0.372–8.124 | 0.482 | |||
Low tumor location < 5 (cm) | 2.954 | 1.289–6.769 | 0.010 | 2.856 | 1.133–7.198 | 0.026 |
Tumor diameter ≥ 4 (cm) | 3.010 | 1.313–6.901 | 0.009 | 2.994 | 1.185–7.563 | 0.020 |
T3-T4 | 1.135 | 0.410–3.142 | 0.807 | |||
Lymph node metastases | 1.719 | 0.748–3.951 | 0.202 | |||
Previous laparotomy | 1.884 | 0.602–5.890 | 0.276 | |||
Preoperative CEA ≥ 5 (ng/mL) | 1.216 | 0.518-2.852 | 0.653 | |||
Preoperative serum albumin level < 35 (g/L) | 1.690 | 0.673–4.244 | 0.264 | |||
Preoperative hemoglobin levels < 90 (g/L) | 1.582 | 0.631–3.967 | 0.328 | |||
Preoperative serum CRP level, ≥ 10 (mg/L) | 2.242 | 0.918–5.476 | 0.076 | |||
ASA score ≥ 3 | 1.244 | 0.499–3.102 | 0.639 | |||
Ligation of left colic artery | 2.435 | 1.019–5.819 | 0.045 | 2.195 | 0.869–5.546 | 0.096 |
Operation time ≥ 150 (min) | 2.437 | 1.059–5.613 | 0.036 | 1.837 | 0.750–4.495 | 0.183 |
Number of staple firings ≥ 3 | 2.577 | 0.893–7.434 | 0.080 | |||
Intraoperative transfusion | 1.116 | 0.316–3.939 | 0.864 | |||
Intraoperative blood loss ≥ 60 (mL) | 1.223 | 0.537–2.787 | 0.632 | |||
Reinforcing sutures | 0.394 | 0.165–0.942 | 0.036 | 0.293 | 0.114–0.750 | 0.010 |
Postoperative intestinal obstruction | 2.263 | 0.848–6.041 | 0.103 |
Table 5 Subgroup analysis of the effectiveness of reinforcing sutures
Reinforcing sutures | Anastomotic leakage | P value | |
Yes | No | ||
Low-risk group | 0.368 | ||
Yes | 1 | 87 | |
No | 4 | 85 | |
High-risk group | 0.038 | ||
Yes | 7 | 73 | |
No | 13 | 49 |
- Citation: Ban B, Shang A, Shi J. Efficacy of staple line reinforcement by barbed suture for preventing anastomotic leakage in laparoscopic rectal cancer surgery. World J Gastrointest Surg 2022; 14(8): 821-832
- URL: https://www.wjgnet.com/1948-9366/full/v14/i8/821.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v14.i8.821