EPD200 - Tissue Sealants As an Adjunct for Colorectal Anastomoses: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

ePoster of Distinction Presenter(s)

• 

  Tyler McKechnie, MD MSc PhD(c) (he/him/his)

  Resident Physician
  McMaster University
  McMaster University
  Hamilton, ON, Canada

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Author(s)

• SR

  Sahaar Rattansi, BSc

  Student
  University of Waterloo
  Waterloo, Ontario, Canada

  Disclosure information not submitted.
• 

  Michael Y. Guo, MD, MHSc

  Resident
  University of British Columbia
  University of British Columbia
  Vancouver, BC, Canada

  Disclosure information not submitted.
• 

  Alessandro Ricci, MD

  General Surgery Resident
  Queen's University
  Queen's University
  Kingston, ON, Canada

  Disclosure information not submitted.
• AB

  Adom Bondzi-Simpson, MD MSc

  PGY4
  University of Toronto
  Toronto, Ontario, Canada

  Disclosure information not submitted.

Senior Author(s)

• 

  Cagla Eskicioglu, MD, MSc (she/her/hers)

  Associate Professor, Surgery
  Division of General Surgery, McMaster University
  Hamilton, ON, Canada

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: Tissue sealants are a promising adjunctive technique for colorectal anastomoses. Previously published clinical data suggest they may decrease the risk of anastomotic leak. These data have never been synthesized. We conducted the present systematic review and meta-analysis to address this gap.

Methods/Interventions: MEDLINE, Embase, and CENTRAL were searched from database inception to December 2024. Randomized controlled trials (RCTs) were included if they compared the use of a tissue sealant to a control as an adjunctive technique during the construction of an anastomosis following colectomy and/or proctectomy. Outcomes included anastomotic leak, postoperative mortality, reoperation, and postoperative length of stay (LOS). A DerSimonian and Laird random effects meta-analysis was performed. Risk of bias was assessed with the Cochrane risk of bias tool and certainty of evidence was assessed with GRADE.

Results/Outcomes: After reviewing 396 citations, five RCTs met inclusion criteria. Overall, 221 patients were in the tissue sealant group (mean age: 66.5 years, 46.2% female) and 232 patients were in the control group (mean age: 65.1 years, 41.1% female). The risk of anastomotic leak was reduced by more than half with the use of tissue sealants (five studies; 7.2% vs. 17.2%, Relative Risk (RR) 0.43, 95% Confidence Intervals (CI) 0.25-0.73, p< 0.001, I2=0%; certainty of evidence: low). Reoperations occurred less frequently in the tissue sealant group (two studies; 4.8% vs. 15.2%, RR 0.32, 95%CI 0.12-0.86, p=0.02, I2=0%; certainty of evidence; very low). Postoperative mortality and postoperative LOS were similar between groups.

Conclusion/Discussion: For every 10 patients treated with tissue sealants at the time of colorectal anastomosis formation, one anastomotic leak could be prevented. However, certainty of evidence was low suggesting that further research may have an important impact on the confidence in these effect estimates. The conduct of a properly powered RCT should be considered.

Forest Plot.
Random effects meta-analysis comparing tissue sealants to controls for anastomotic leak.