Dear Editor
The meta-analysis on intraoperative bowel perfusion assessment methods and their effects on anastomotic leak rates1 makes a significant contribution to the surgical literature by synthesizing results from various studies to assess the role of intraoperative bowel perfusion assessment technologies in reducing anastomotic leaks in colorectal surgery. Nevertheless, we raise a few questions that need further exploration. First, the study fails to specify the sample size, study design, or quality of the individual studies, raising concerns about the robustness and applicability of the findings. A more in-depth analysis including a forest plot and funnel plot would provide a clearer perspective on the heterogeneity and risk of bias among the included studies. Second, the analysis does not take into account the operator dependency of these assessment methods. The results from these technologies largely depend on the skill and experience of the surgeon or the staff operating them. It would be interesting to explore how much of the reported reduction in anastomotic leak is attributable to the technology itself versus the surgical experience and skill. Furthermore, the study does not address the cost-effectiveness of these assessment technologies. Incorporating a cost analysis could provide a comprehensive overview to help healthcare institutions in their decision-making processes regarding the adoption of these technologies. Lastly, the study does not delve into how these technologies are used to alter surgical decision-making and how these alterations affect outcomes. It would be beneficial to explore how often these technologies change the surgical plan and how this translates into patient outcomes. In summary, although this meta-analysis represents a valuable step forward in understanding the role of perfusion assessment technologies, addressing the above areas could lend further credence to their efficacy and utility.
Contributor Information
Yi Liu, Medical Cosmetic Centre, Chengdu Second People’s Hospital, Qingyun Nan Road, Jinjiang District, 61000 Chengdu, China.
Chenyu Chu, Division of Plastic and Reconstructive Surgery, Department of Surgery, Boston University School of Medicine, 609 Albany St., Boston, MA 02118, USA.
Qing Li, Medical Cosmetic Centre, Chengdu Second People’s Hospital, Qingyun Nan Road, Jinjiang District, 61000 Chengdu, China.
Yin Zhou, Medical Cosmetic Centre, Chengdu Second People’s Hospital, Qingyun Nan Road, Jinjiang District, 61000 Chengdu, China.
Author contributions
Yi Liu (Writing—review & editing), Chenyu Chu (Writing—original draft & reviewing), Qing Li (Reviewing), and Yin Zhou (Supervision, review & editing)
Reference
- 1. Renna MS, Grzeda MT, Bailey J, Hainsworth A, Ourselin S, Ebner Met al. . Intraoperative bowel perfusion assessment methods and their effects on anastomotic leak rates: meta-analysis. Br J Surg 2023;110:1131–1142 [DOI] [PMC free article] [PubMed] [Google Scholar]