TY - JOUR
T1 - Coating of Intestinal Anastomoses for Prevention of Postoperative Leakage
T2 - A Systematic Review and Meta-Analysis
AU - Cira, Kamacay
AU - Stocker, Felix
AU - Reischl, Stefan
AU - Obermeier, Andreas
AU - Friess, Helmut
AU - Burgkart, Rainer
AU - Neumann, Philipp Alexander
N1 - Publisher Copyright:
Copyright © 2022 Cira, Stocker, Reischl, Obermeier, Friess, Burgkart and Neumann.
PY - 2022/4/22
Y1 - 2022/4/22
N2 - Background: For several decades, scientific efforts have been taken to develop strategies and medical aids for the reduction of anastomotic complications after intestinal surgery. Still, anastomotic leakage (AL) represents a frequently occurring postoperative complication with serious consequences on health, quality of life, and economic aspects. Approaches using collagen and/or fibrin-based sealants to cover intestinal anastomoses have shown promising effects toward leak reduction; however, they have not reached routine use yet. To assess the effects of covering intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative leakage, a systematic review and meta-analysis were conducted. Method: PubMed, Web of Science, Cochrane Library, and Scopus (01/01/1964 to 17/01/2022) were searched to identify studies investigating the effects of coating any intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative AL, reoperation rates, Clavien–Dindo major complication, mortality, and hospitalization length. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Overall, 15 studies (five randomized controlled trials, three nonrandomized intervention studies, six observational cohort studies) examining 1,387 patients in the intervention group and 2,243 in the control group were included. Using fixed-effects meta-analysis (I2 < 50%), patients with coated intestinal anastomoses presented significantly lower AL rates (OR = 0.37; 95% CI 0.27–0.52; p < 0.00001), reoperation rates (OR, 0.21; 95% CI, 0.10–0.47; p = 0.0001), and Clavien–Dindo major complication rates (OR, 0.54; 95% CI, 0.35–0.84; p = 0.006) in comparison to controls, with results remaining stable in sensitivity and subgroup analyses (stratified by study design, age group, intervention used, location of anastomoses, and indication for surgery). The length of hospitalization was significantly shorter in the intervention group (weighted mean difference (WMD), −1.96; 95% CI, −3.21, −0.71; p = 0.002) using random-effects meta-analysis (I2≥ 50%), especially for patients with surgery of upper gastrointestinal malignancy (WMD, −4.94; 95% CI, −7.98, −1.90; p = 0.001). Conclusion: The application of collagen-based laminar biomaterials or fibrin sealants on intestinal anastomoses can significantly reduce postoperative rates of AL and its sequelae. Coating of intestinal anastomoses could be a step toward effective and sustainable leak prevention. To assess the validity and robustness of these findings, further clinical studies need to be conducted.
AB - Background: For several decades, scientific efforts have been taken to develop strategies and medical aids for the reduction of anastomotic complications after intestinal surgery. Still, anastomotic leakage (AL) represents a frequently occurring postoperative complication with serious consequences on health, quality of life, and economic aspects. Approaches using collagen and/or fibrin-based sealants to cover intestinal anastomoses have shown promising effects toward leak reduction; however, they have not reached routine use yet. To assess the effects of covering intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative leakage, a systematic review and meta-analysis were conducted. Method: PubMed, Web of Science, Cochrane Library, and Scopus (01/01/1964 to 17/01/2022) were searched to identify studies investigating the effects of coating any intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative AL, reoperation rates, Clavien–Dindo major complication, mortality, and hospitalization length. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Overall, 15 studies (five randomized controlled trials, three nonrandomized intervention studies, six observational cohort studies) examining 1,387 patients in the intervention group and 2,243 in the control group were included. Using fixed-effects meta-analysis (I2 < 50%), patients with coated intestinal anastomoses presented significantly lower AL rates (OR = 0.37; 95% CI 0.27–0.52; p < 0.00001), reoperation rates (OR, 0.21; 95% CI, 0.10–0.47; p = 0.0001), and Clavien–Dindo major complication rates (OR, 0.54; 95% CI, 0.35–0.84; p = 0.006) in comparison to controls, with results remaining stable in sensitivity and subgroup analyses (stratified by study design, age group, intervention used, location of anastomoses, and indication for surgery). The length of hospitalization was significantly shorter in the intervention group (weighted mean difference (WMD), −1.96; 95% CI, −3.21, −0.71; p = 0.002) using random-effects meta-analysis (I2≥ 50%), especially for patients with surgery of upper gastrointestinal malignancy (WMD, −4.94; 95% CI, −7.98, −1.90; p = 0.001). Conclusion: The application of collagen-based laminar biomaterials or fibrin sealants on intestinal anastomoses can significantly reduce postoperative rates of AL and its sequelae. Coating of intestinal anastomoses could be a step toward effective and sustainable leak prevention. To assess the validity and robustness of these findings, further clinical studies need to be conducted.
KW - anastomotic leakage (AL)
KW - coated collagen patch
KW - fibrin glue (FG)
KW - fibrin sealant
KW - intestinal anastomoses
UR - http://www.scopus.com/inward/record.url?scp=85129678350&partnerID=8YFLogxK
U2 - 10.3389/fsurg.2022.882173
DO - 10.3389/fsurg.2022.882173
M3 - Review article
AN - SCOPUS:85129678350
SN - 2296-875X
VL - 9
JO - Frontiers in Surgery
JF - Frontiers in Surgery
M1 - 882173
ER -