A novel knotless hand-sewn end-to-end anastomosis using V-loc barbed suture vs. stapled anastomosis in laparoscopic left colonic surgery: A propensity scoring match analysis

Shining Xu; Xuan Zhao; Zirui He; Xiao Yang; Junjun Ma; Feng Dong; Lu Zang; Abe Fingerhut; Luyang Zhang; Minhua Zheng

doi:10.3389/fsurg.2022.963597

A novel knotless hand-sewn end-to-end anastomosis using V-loc barbed suture vs. stapled anastomosis in laparoscopic left colonic surgery: A propensity scoring match analysis

Front Surg. 2022 Nov 2:9:963597. doi: 10.3389/fsurg.2022.963597. eCollection 2022.

Authors

Shining Xu^{1

2}, Xuan Zhao^{1

2}, Zirui He^{1

2}, Xiao Yang^{1

2}, Junjun Ma^{1

2}, Feng Dong^{1

2}, Lu Zang^{1

2}, Abe Fingerhut^{1

2

3}, Luyang Zhang^{1

2}, Minhua Zheng^{1

2}

Affiliations

¹ Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Section for Surgical Research and Department of General Surgery, Medical University of Graz, Graz, Austria.

Abstract

Background: Laparoscopic colectomy is widely practiced for colon cancer, but many variations exist for anastomosis after laparoscopic colon cancer radical resection.

Method: We retrospectively analyzed 226 patients who underwent laparoscopic-assisted radical resection for left colon cancer with knotless hand-sewn end-to-end anastomosis (KHEA) technique with barbed V-loc™ suture material and compared perioperative outcomes, safety, and efficacy to those undergoing stapled anastomosis from 2010 to 2021.

Results: After the 1:2 propensity score matching, 123 participants with similar preoperative characteristics (age, body mass index, TNM stage, and tumor location) were enrolled in the study: 41 in the KHEA and 82 in the stapler group. Statistically significant differences were found in time to accomplish the anastomosis (mean 7.9 vs. 11.9 min, p < 0.001) and hospital costs (mean 46,569.71 vs. 50,915.35 CNY, p < 0.05) that differed between the KHEA and stapler group, respectively. No statistically significant difference was found in the mean delay to bowel function recovery (2.6 vs. 2.7 days, p = 0.466), duration of hospital stay (8.6 vs. 7.9 days, p = 0.407), or rate of postoperative complications (14.6% vs. 11.0%, p = 0.563). Anastomotic leakage occurred in 11 patients: 5 (12.2%) vs. 6 (7.3%) (p > 0.05) in the KHEA and stapler group, respectively.

Conclusion: KHEA is feasible and safe for anastomosis after laparoscopic left hemicolectomy. The KHEA technique could reduce operation time and hospital costs with complication rates comparable to stapling.

Keywords: barbed suture; colon cancer; extracorporeal anastomosis; intracorporeal anastomosis; laparoscopic surgery; left colon anastomosis; left hemicolectomy.