Purpose Anastomotic leakage (AL) is a major complication of anterior resection of rectal cancer. Reinforcement sutures at the anastomotic staple line may reduce the risk of AL; however, their efficacy remains uncertain. This meta-analysis evaluated the effectiveness of staple line reinforcement in preventing AL. Methods A systematic review and meta-analysis were conducted following the PRISMA guidelines (PROSPERO registration; CRD42024581347). Literature published between January 2000 and August 2024 was searched. Randomized controlled trials (RCTs) and observational studies (OBSs) comparing reinforcement sutures with non-reinforcement sutures were included. The primary outcome was AL incidence, and secondary outcomes included reoperation rates, operative time, and mortality. Data were analyzed using a random-effects model. Results One RCT and eight OBSs were included, with a meta-analysis performed only for OBSs. Reinforcement sutures significantly reduced AL (odds ratio [OR], 0.29; 95% confidence interval [CI] 0.18–0.46; p < 0.000001), with low heterogeneity (I2 = 0%). A subgroup analysis excluding diverting stoma (DS) creation confirmed reduced AL (OR, 0.41; 95% CI 0.27–0.62; p < 0.0001). The reoperation rate was also lower (OR, 0.32; 95% CI 0.14–0.72; p = 0.006). The mortality and operative time were unaffected. Conclusions Reinforcement sutures can reduce the AL and reoperation rates in patients with rectal cancer undergoing stapled anastomosis. Large-scale RCTs are required to confirm the optimal benefits and long-term effects.

The ACS recommends guidelines of behavior for the physician acting as an expert witness.

Background Posthepatectomy liver failure (PHLF), the most serious complication after hepatectomy, may evoke multisystemic complications and even mortality. Despite numerous studies demonstrated the safety and efficacy of controlled low central venous pressure (CLCVP), the optimal central venous pressure (CVP) maintenance level during CLCVP and its relationship with PHLF remain controversial. Therefore, the present study aimed to evaluate the association between the lowest CVP maintenance level during CLCVP and PHLF. Methods 755 patients who underwent laparoscopic hepatectomy at Sun Yat-Sen Memorial Hospital between January 2017 and March 2021 were recruited. Univariate and multivariate analyses were performed to determine the effect of the lowest CVP maintenance level on PHLF. After implementing propensity score matching (PSM) to equalize demographic confounders, univariate comparisons and subgroup analyses were conducted to investigate the impact of the lowest CVP maintenance level on PHLF in patients who underwent CLCVP. Results Univariate and multivariate analyses identified intraoperative lowest CVP maintenance level < 2 mmHg as an independent risk factor for PHLF (P = 0.041; OR, 0.520; 95% CI 0.277 to 0.974). Following 1:1 PSM in individuals who received CLCVP, the lowest CVP maintenance level < 2 mmHg was associated with heightened PHLF incidence (P = 0.048) and elevated intraoperative lactate level (P = 0.011). Subgroup analyses revealed that the above effect of the lowest CVP maintenance level occurred mainly in elderly individuals or those with prolonged portal blockade. Conclusion During laparoscopic hepatectomy, excessively low CVP maintenance level should be avoided to decrease the risk of tissue malperfusion and PHLF, especially in elderly or prolonged portal blockade patients.