Transanal tube for the prevention of anastomotic leakage in rectal cancer surgery

Anastomotic leakage is a serious complication of rectal cancer surgery that increases morbidity and healthcare burden. A transanal tube placed near the anastomosis may reduce spasms and drain stool, potentially lowering leakage risk. A systematic review included four randomized controlled trials with 1318 participants (666 in the transanal tube group, 652 in the no-intervention group). The evidence is very uncertain about the effect of a transanal tube on anastomotic leakage risk (RR 0.88; 95% CI 0.46 to 1.72), with anticipated absolute risk of 83 per 1000 without intervention and 73 per 1000 with the tube. A transanal tube may reduce the risk of surgical re-intervention for anastomotic leakage (RR 0.32; 95% CI 0.10 to 1.00), with anticipated absolute risk of 45 per 1000 without intervention and 14 per 1000 with the tube. The evidence is very uncertain about the effect on postoperative adverse events other than anastomotic leakage (RR 1.19; 95% CI 0.76 to 1.88). Overall certainty of evidence was very low to low.