The Efficacy Of Different Suture Reinforcement Methods For Preventing Anastomotic Leakage Of Colorectal Anastomosis After Laparoscopic Double Stapling Technique:A Prospective Cohort Study

ObjectiveTo evaluate the correlation between double stapling technique(DST)with anastomotic leakage(AL),and to explore the efficacy of different suture reinforcement methods for AL and other anastomosis-related complications after laparoscopic rectal anastomosis.MethodThis is a prospective cohort study,involving 135 patients who underwent laparoscopic DST were divided into 3 groups.In the first group,patients received interrupted suture with VircylTM of lateral intersecting staple lines.In the second group,patients received continuous suture to reinforce the anterior wall and lateral intersecting staple lines of anastomosis with V-LocTM.While control group was not reinforced.Several clinical manifestations,laboratory examinations and other indicators were observed postoperatively to determine whether patients had anastomotic leakage,and assessed the severity of AL,postoperative hospitalization days and risk of surgical intervention.Result135 patients were analyzed in this study,including 85 males and 50 females with an average age of 61.6 years.The average operative time of three groups was 105.7±30.6 min with an average intraoperative blood loss of 90.5±51.9 ml.9 subjects were clinically diagnosed as AL(7.26%,with 11 patients met the withdrawal criteria).The incidence of severe AL(grade C)in interrupted suture group and continuous suture group was significantly lower than control group(?2=0.019,P=0.016,Fisher's exact Test).The average length of hospital stay of patients with AL in interrupted suture group was 30.5(19-42)days,while in the continuous suture group was 41(37-43)days,which was significantly less than that in control group(Z=6.162,P=0.046,Kruskal Wallis Test).In addition,the average cost of interrupted suture group was 71142.6±2849.3 yuan,with continuous suture group of 71360.1±2072.3 yuan,significantly lower than that of control group(F=10.064,P=0.009,Univariate ANOVA Analysis).As for control group,4(100%)patients received re-surgical intervention,which was significantly higher than 0(0%)patients in interrupted suture group and 1(33.3%)patients in continuous suture group(?2=5.616,P=0.043,Fisher's Exact Test).Meanwhile,the overall incidence risk of anastomotic bleeding was 0.74%(1 case),and other postoperative surgical complications showed no significant difference among this three groups(?2=1.968,P=0.374,Fisher's Exact Test).ConclusionThe application of interrupted suture with VircylTM for the reinforcement of lateral intersecting staple lines or continuous suture with V-LocTM for the reinforcement of both lateral intersecting staple lines and anterior wall of anastomosis after laparoscopic DST can reduce the severity of the AL,shorten hospitalization time and reduce the cost of treatment,not increasing the risk of technical difficulty and other postoperative complications.This two kinds of suture reinforcement methods for prevention of AL are safe,feasible and effective.