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A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer

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Abstract

Background

The safety and efficacy of transanal drainage tube (TDT) placement to decrease the risk of postoperative anastomotic leakage after rectal cancer surgery has not been validated. The objective of this meta-analysis was to evaluate the usefulness of a TDT for the prevention of anastomotic leakage after an anterior resection for rectal cancer.

Methods

The PubMed and Cochrane Library databases were searched for studies comparing TDT and non-TDT. The endpoint utilized in this study was defined as the rates of anastomotic leakage and re-operation. The relative effects of these variables were synthesized using Review Manager 5.1 software.

Results

Four trials including 909 participants (401 TDT cases and 508 non-TDT cases) met our inclusion criteria. The weighted mean anastomotic leakage rate was 4 % [95 % confidence interval (CI) 1–6 %], and a significantly lower risk of anastomotic leakage was identified in the TDT group compared with the non-TDT group [odds ratio (OR) 0.30; 95 % CI 0.16–0.55; p = 0.0001]. Furthermore, there were significant differences between the TDT and non-TDT groups in terms of the re-operation rate (OR 0.18; 95 % CI 0.07–0.44; p = 0.0002). No significant covariates related to anastomotic leakage or re-operation were identified in meta-regression analysis. Both the anastomotic leakage and re-operation rates for all studies lay inside the 95 % confidence interval boundaries. No visible publication bias was found by visual assessment of the funnel plot (Egger’s test; anastomotic leakage: p = 0.056, re-operation: p = 0.681).

Conclusions

Placement of a TDT is an effective and safe procedure that can decrease the rate of anastomotic leakage and re-operation after an anterior resection.

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Disclosures

Kohei Shigeta, MD, PhD, Koji Okabayashi, MD, PhD, Hideo Baba MD, Kazuo Yamafuji MD, PhD, Hirotoshi Hasegawa MD, PhD, Masashi Tsuruta MD, PhD, Kiyoshi Kubochi MD, PhD, and Yuko Kitagawa MD, PhD, have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Kohei Shigeta, Koji Okabayashi, Hirotoshi Hasegawa, Masashi Tsuruta & Yuko Kitagawa

  2. Department of Surgery, Saitama City Hospital, Saitama, Japan

    Kohei Shigeta, Hideo Baba, Kazuo Yamafuji & Kiyoshi Kubochi

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  1. Kohei Shigeta
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Correspondence to Kohei Shigeta or Koji Okabayashi.

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Shigeta, K., Okabayashi, K., Baba, H. et al. A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer. Surg Endosc 30, 543–550 (2016). https://doi.org/10.1007/s00464-015-4237-3

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  • DOI: https://doi.org/10.1007/s00464-015-4237-3

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