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Page 6 of 16 Park et al. Mini-invasive Surg 2020;4:87 I http://dx.doi.org/10.20517/2574-1225.2020.87

P I 2
P

Figure 2. Meta-analysis of anastomotic leakage

by the significant difference in average body mass index (BMI) of the patient cohort included in the study
[Table 1] .
[12]

Study characteristics and demographic data
The surgical technique used to perform IA anastomosis was similar in all included studies. A mechanical
linear stapler was the method of choice for bowel anastomosis for both intracorporeal and extracorporeal
approach, reported in all 24 articles. However, a large variation was noted among published literature for
the closure of enterotomies and the length of anastomosis.

The overall mean age, reported in twenty-three articles, was 65.7 years in the IA group and 66.0 years in the
EA group. The male to female ratio was 1.1:1 for IA cohort and 1:1 for the EA. The average BMI, reported
2
2
in 23 papers, was 25.8 kg/m for the IA cohort and 26.0 kg/m for the EA group.
Quality assessment: modified Institute of Health Economics quality appraisal tool
[35]
The modified Institute of Health Economics (IHE) quality appraisal tool used is displayed in Supplement Table 1 .
The assessment was conducted for 21 comparative, non-randomised studies. The mean score was 24.2 (range
21-28) out of a total of 30 points. Study with a score ≥ 26 was considered of high quality.

Meta-analysis
Primary outcome
Anastomotic Leakage: The overall rate of anastomotic leakage [Figure 2] reported in 24 articles was 3.1% (44
cases) for the IA and 3.9% (49 cases) for the EA. The meta-analysis did not reveal a statistically significant
2
difference (OR = 0.84; 95%CI: 0.54-1.31; P = 0.44; I = 0%).
Secondary outcomes
Operative time: The operative time [Figure 3] was reported in 21 studies. It was 10 min longer for IA (MD
2
= 9.99 min; 95%CI: 3.68-16.31; P = 0.002; I = 85%), which was statistically significant.