Abstract: Objective:To investigate the application value of barbed suture in reinforcing anastomosis during laparoscopic radical resection of rectal cancer.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 215 patients with rectal cancer who underwent laparoscopic radical resection in the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2016 to December 2018 were collected. There were 122 males and 93 females, aged (62.3±0.7)years, with a range from 20 to 75 years. Of 215 patients, 86 patients undergoing laparoscopic radical resection of rectal cancer with barbed suture for anastomosis were allocated into barbed suture group, and 129 patients undergoing laparoscopic radical resection of rectal cancer without reinforced anastomosis were allocated into traditional group, respectively. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications, anastomotic healing and patency of patients up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Ordinal data were analyzed using the Friedman non-parametric test.
Results: (1) Intraoperative situations: patients in the two groups underwent laparoscopic radical resection of rectal cancer successfully, without conversion to open laparotomy. The volume of intraoperative blood loss, operation time, distance between the anastomosis and dentate line, length of auxiliary incision of the barbed suture group were (127±9)mL, (160.2±3.8)minutes, (3.56±0.15)cm, (4.12±0.11)cm,respectively, versus (114± 6)mL, (128.9±2.4)minutes, (3.67±0.12)cm, (4.25±0.09)cm of the traditional group. There was a significant difference in the operation time between the two groups (t=7.33, P<0.05), but no significant difference in the other indicators between the two groups (t=1.32, 0.61, 0.94, P>0.05). (2) Postoperative situations: the time to first flatus after surgery and duration of postoperative hospital stay of the barbed suture group were (72.5± 2.2)hours and (8.1±0.5)days, respectively, versus (76.2±1.7)hours and (8.0±0.5)days of the traditional group, showing no significant difference between the two groups (t=1.33, 0.87, P>0.05). (3) Follow-up: 215 patients were followed up for 6-12 months, with a median follow-up time of 8 months. In the barbed suture group, 2 patients had postoperative anastomotic leakage, 5 had urinary retention, 6 had incision infection, 4 had intestinal obstruction, 3 had bowel dysfunction in 6 months after operation. In the traditional group, 13 patients had postoperative anastomotic leakage, 15 had urinary retention, 11 had incision infection, 8 had intestinal obstruction, 9 had bowel dysfunction in 6 months after operation. There was a significant difference in the anastomotic leakage between the two groups (t=4.77, P<0.05), but no significant difference in the urinary retention, incision infection, intestinal obstruction, bowel dysfunction in 6 months after operation between the two groups (t=2.07, 0.17, 0.22, 1.26, P>0.05). Patients in the two groups showed unobstructed intestinal tract on enteroscopy.
Conclusion:The barbed suture for reinforcing anastomosis in radical resection of rectal cancer is safe and feasible, which can reduce the incidence of anastomotic leakage.