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

Feng-Bing Wang; Min-Min Song; Nian-Wen Zhang; Wei-Feng; Bin-Liu; Peng-Fei Zhang

doi:10.15537/smj.2025.46.1.20240422

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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.
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Figure 2
- Flow diagram of study selection.
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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.
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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.
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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
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Figure 6
- Forest plot of the operation time.

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Table 1

- Quality evaluation of the included articles (CCS) using the Newcastle-Ottawa scale.

Authors	Year	Type of study	Research object selection (0-4)	Intergroup comparability (0-2)	Outcome indicators(0-3)	Total (0-9)
WU et al¹⁶	2022	CCS	****	**	*	7
Jin et al²⁰	2022	CCS	****	**	*	7
LI et al²¹	2023	CCS	****	**	*	7
Luo et al²²	2020	CCS	****	**	***	9
Ban et al¹⁰	2022	CCS	****	**	*	7
Maeda et al²³	2015	CCS	****	**	*	7
Hashida et al¹³	2022	CCS	****	**	*	7
Zhang et al²	2023	CCS	****	**	*	7
jiang et al²⁴	2020	CCS	****	**	*	7
Lin et al²⁵	2022	CCS	****	**	*	7
Liu et al²⁶	2022	CCS	****	**	*	7
Sheng et al²⁷	2024	CCS	****	**	*	7

One star for each point, maximum of 9 stars.

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Table 2

- Characteristics of all included studies.

Authors	Year	Country	Type of tudy	Sample size		Gender (male/female)
Authors	Year	Country	Type of tudy	Experimental	Control	Experimental	Control
Zhang et al¹⁵	2018	China	RCT	60	60	31/29	9/31
WU et al¹⁶	2022	China	CCS	84	170	46/38	106/64
LI et al¹⁷	2021	China	RCT	101	100	54/47	52/48
He et al¹⁸	2018	China	RCT	145	146	78/67	85/61
YANG et al¹⁹	2022	China	RCT	38	38	20/18	20/18
Jin et al²⁰	2022	China	CCS	123	135	75/48	84/51
LI et al²¹	2023	China	CCS	119	119	64/55	51/68
Luo et al²²	2020	China	CCS	86	129	51/35	71/58
Ban et al¹⁰	2022	China	CCS	168	151	80/88	73/78
Maeda et al²³	2015	Japan	CCS	91	110	52/39	62/44
Hashida et al¹³	2022	Japan	CCS	72	81	38/34	45/36
Zhang et al²	2023	China	CCS	117	117	68/49	69/48
jiang et al²⁴	2020	China	CCS	82	42	53/29	23/19
Lin et al²⁵	2022	China	CCS	123	123	67/56	65/58
Liu et al²⁶	2022	China	CCS	63	68	39/24	44/24
Sheng et al²⁷	2024	China	CCS	40	46	25/15	28/18

Authors	Age, mean ± SD (years)		BMI, mean±SB (kg/m²)
Authors	Experimental	Control	Experimental	Control
Zhang et al¹⁵	53.67±14.22	55.18±13.78	22.35±2.81	21.79±3.11
WU et al¹⁶	58.51±10.99	60.14±11.12	23.25±3.44	23.87±3.08
LI et al¹⁷	46.00±15.59	49.00±16.79	NA	NA
He et al¹⁸	65.2±15.3		NA	NA
YANG et al¹⁹	52.19±6.20	52.16±6.22	NA	NA
Jin et al²⁰	61.81±13.46	61.95±11.62	23.26±4.71	23.40±3.02
LI et al²¹	64.09±13.16	62.97±13.62	22.58±2.76	22.83±2.96
Luo et al²²	62.8±1.00	60.70±1.00	22.10±0.3	21.90±1.30
Ban et al¹⁰	61.8±8.7	63.7±9.7	23.3±3.6	22.8±3.8
Maeda et al²³	NA	NA	NA	NA
Hashida et al¹³	68.1	68.6	22.9	23
Zhang et al²	66	66	23.8	23.9
jiang et al²⁴	61.35±12.4	61.6±11.4	23.37±2.82	22.35±2.95
Lin et al²⁵	65.00	60.00	22.32	21.51
Liu et al²⁶	39-89	37-86	NA	NA
Sheng et al²⁷	55.03±7.82	53.91±7.54	23.21±1.29	23.54±1.38

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Table 3

- General information of the included studies.

Authors	Tumor location (cm)		Tumor size, mean±SD (cm)		TNM (0 / I / II / III)		Method of suture
Authors	Experimental	Control	Experimental	Control	Experimental	Control	Experimental	Control
Zhang et a ^l¹⁵	7.54±2.12	6.59±1.87	NA	NA	0/22/18/20	0/23/20/17	Laparoscopic reinforcing sutures	No
WU et al ¹⁶	NA	NA	4.10±1.30	4.21±1.35	0/I+II:35/49	0/I+II:68/102	Laparoscopic reinforcing sutures	No
LI et al ¹⁷	7.09±2.76	6.95±2.57	4.07±1.45	3.98±1.58	0/20/56/25	0/20/54/26	Laparoscopic reinforcing sutures	No
He et al ¹⁸	NA	NA	NA	NA	NA	NA	Laparoscopic reinforcing sutures	No
YANG et al ¹⁹	NA	NA	3.64±0.42	3.44±0.46	NA	NA	Laparoscopic reinforcing sutures	No
Jin et al ²⁰	9.25±2.69	8.53±3.31	3.76±1.66	3.77±1.42	2/23/58/40	1/18/57/59	Laparoscopic reinforcing sutures	No
LI et al ²¹	7.53±2.52	7.46±2.49	3.38±1.57	3.26±1.35	0/45/49/25	0/37/50/32	Laparoscopic reinforcing sutures	No
Luo et al ²²	NA	NA	4.3±0.20	4.60±0.20	0/14/50/22	0/26/70/32	Laparoscopic reinforcing sutures	No
Ban et al ¹⁰	NA	NA	4.4±1.7	4.1±1.8	NA	NA	Laparoscopic reinforcing sutures	No
Maeda et al ²³	NA	NA	NA	NA	NA	NA	Laparoscopic reinforcing sutures	No
Hashida et al ¹³	6.2	6.8	3.8	3.5	NA	NA	Laparoscopic reinforcing sutures	No
Zhang et al ²	10	9.0	3.5	3.5	NA	NA	Laparoscopic reinforcing sutures	No
jiang et al ²⁴	NA	NA	NA	NA	18/18/29/2	11/14/15/1	Laparoscopic reinforcing sutures	No
Lin et al ²⁵	7.00	7.00	4.00	4.00	0/10/41/72	0/7/43/73	Laparoscopic reinforcing sutures	No
Liu et al ²⁶	NA	NA	NA	NA	0/13/29/21	0/12/33/23	Laparoscopic reinforcing sutures	No
Sheng et al ²⁷	NA	NA	2.43±0.71	2.51±0.67	0/5/18/17	0/6/21/19	Laparoscopic reinforcing sutures	No

RCT: randomized controlled tria, CCS: case-control study, Experimental: reinforcement and suture, Control: unreinforced, NA: not available, BMI: body mass index, Tumor location: Tumor site from anal verge, TNM: AJCC staging