Autologous Materials Reinforcement For Prevention Of Anastomotic Leakage After Colorectal Surgery

Objective:Anastomotic leak(AL)is a life-threatening complication after colorectal surgery.It is controversial whether autologous materials can improve the incidence of AL after colorectal surgery and the serious consequences of complications.This article will systematically evaluate the effect of autologous material reinforcement on the incidence of AL after colorectal surgery and conduct a meta-analysis.Method:A comprehensive search was conducted on the Pubmed database.The search time ranged from database construction to October 2018.The comparison or randomized controlled trial(RCTs)on the incidence of AL after colorectal surgery for all relevant autologous materials to reinforce the anastomotic site was searched.The search term was: "Colorectal surgery 'or' colorectal 'or' colon 'or' rectum '" and " anastomotic leak ",in languages limited to "English" and biological species limited to "Humans".References for related studies were also collected,and duplicated literatures were excluded.Two researchers evaluated the included trials based on the Cochrane systematic review.For controversial literature that is difficult to determine,it can be determined by discussion or by a third researcher.Data analysis using Revman5.3 software.Result: A preliminary search of 1504 related documents,after removing the duplicated published literature,after careful screening of the titles and abstracts of each of the documents,1491 obviously inconsistent literatures were excluded,and 10 documents were initially identified for further screening.After reading the full text,5 non-comparative trials and 1 unreported AL literature were further excluded.Finally,4 literatures(3 RCTs,1 comparative trial)were included in this meta-analysis.The total sample size of the study was 3,834,including 524 people who were reinforced with autologous materials during colorectal surgery,and 3,292 patients who did not implement autologous materials during colorectal surgery.The results showed that autologous material reinforcement was effective.Reduced the incidence of AL in colorectal surgery(RR: 0.59;95% CI: 0.39-0.91;P = 0.02;I2 = 34%)and the incidence of clinical AL(RR: 0.36;95% CI: 0.16-0.78;P = 0.01;I2 = 0).AL incidence rate in imaging diagnosis,mortality,incidence of wound rupture,rate of reoperation,sepsis,incidence of early wound abscess,incidence of localized or diffuse peritonitis,incidence of anastomotic stenosis,incidence of abdominal incisional hernia,and incidence of abdominal incisional hernia There was no statistically significant difference in hospitalization time.Patients who have undergone autologous material-reinforced anastomosis have increased in readmission rates(RR: 1.76;95% CI: 1.10-2.82;p=0.02).Conclusion:This study demonstrates that autologous material-reinforced anastomosis in colorectal surgery is effective in reducing the incidence of AL.