title: Efficacy of intracorporeal reinforcing sutures for anastomotic leakage after laparoscopic surgery for rectal cancer.
abstract: BACKGROUND
  The aim of the present study was to investigate the efficacy of intracorporeal reinforcing sutures for preventing anastomotic leakage (AL) after laparoscopic surgery for rectal cancer.
  
  
  METHODS
  This was a retrospective single-institution study consisting of 201 consecutive patients who underwent laparoscopic proctectomy with double-stapling anastomosis for primary rectal cancer between August 2007 and December 2013. The data for patients who received intracorporeal reinforcing sutures were compared with those of patients who did not receive reinforcing sutures. Patient-, tumor- and surgery-related variables were collected and examined using univariate and multivariate analyses.
  
  
  RESULTS
  The overall incidence of AL was 9.0% (18/201). No significant correlations were observed between the various clinicopathological factors and the use of reinforcing sutures. The multivariate analyses revealed the distance of the tumor from the anal verge, tumor size and presence of reinforcing sutures to be independent risk factors for AL. We classified the patients into two risk groups using a combination of the tumor site and tumor size: a low-risk group (patients without any risk factors, n = 134) and a high-risk group (patients with one or two risk factors, n = 67). The frequency of AL was significantly lower (p < 0.02) in the patients treated with reinforcing sutures than in those treated without reinforcing sutures in the high-risk group. However, no significant differences were observed in the low-risk group.
  
  
  CONCLUSIONS
  The use of intracorporeal reinforcing sutures may reduce the incidence of AL. A prospective randomized trial is required to evaluate the effects of reinforcing sutures in preventing AL.
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan. m1378386@med.osaka-cu.ac.jp.
authors: Kiyoshi
authors: K
authors: Maeda
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Hisashi
authors: H
authors: Nagahara
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Masatsune
authors: M
authors: Shibutani
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Hiroshi
authors: H
authors: Ohtani
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Katsunobu
authors: K
authors: Sakurai
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Takahiro
authors: T
authors: Toyokawa
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Kazuya
authors: K
authors: Muguruma
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Hiroaki
authors: H
authors: Tanaka
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Ryosuke
authors: R
authors: Amano
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Kenjiro
authors: K
authors: Kimura
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Kenji
authors: K
authors: Sugano
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Teturo
authors: T
authors: Ikeya
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Yasuhito
authors: Y
authors: Iseki
authors: Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan.
authors: Kosei
authors: K
authors: Hirakawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000517:prevention & control*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012811:Sigmoid Neoplasms / Q000601:surgery; D013536:Suture Techniques
keywords: Anastomotic leakage; Laparoscopic surgery; Rectal cancer; Reinforcing suture