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<p>Anastomotic leakage (AL) remains a significant complication in colorectal surgery despite advances in surgical techniques. This systematic review evaluates clinical outcomes associated with different anastomotic techniques and identifies evidence-based strategies for preventing AL. A comprehensive search identified 1,750 potential studies. Following rigorous screening based on methodological quality, relevance, and outcome reporting, <i>30 high-quality papers were selected for analysis</i>. Studies included meta-analyses, randomized controlled trials, and well-designed observational studies published between 1980 and 2023. <i>Meta-analyses were conducted for three key interventions using a random-effects model.</i> AL incidence ranged from 3–19%, varying by anatomical location. No consistent differences in AL rates were found between stapled and hand-sewn anastomoses in most colorectal procedures, though stapled techniques demonstrated superiority in ileocolic surgery. Surgeon specialization significantly influenced outcomes with lower leak rates for colorectal specialists compared to general surgeons. Meta-analyses demonstrated that indocyanine green fluorescence angiography reduced AL risk by 55%, anastomotic reinforcement sutures by 58%, and polyglycolic acid sheets by 72%. Additional effective strategies included combined oral and intravenous antibiotic prophylaxis and multi-component perioperative care protocols. No single anastomotic technique demonstrates clear superiority across all colorectal procedures. The evidence supports a multifaceted approach to AL prevention incorporating surgical expertise, technical refinements, and optimized perioperative care. Future research should focus on standardizing techniques and validating emerging prevention strategies through large-scale trials.</p>

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Evidence-Based Approaches to Reduce Anastomotic Leakage in Colorectal Surgery: A Systematic Review of Techniques and Prevention Strategies

  • 期刊论文

  • 发表日期：

    2025年11月13日

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  • Fahim Kanani,
  • Nuha Riya,
  • Mahmoud Abdelrazzaq Abu Mayaleh,
  • Osama Ewidat,
  • Narmin Zoabi,
  • Nir Messer,
  • Alaa Zahalka,
  • Aviad Gravets,
  • Nesher Eviatar

摘要

Anastomotic leakage (AL) remains a significant complication in colorectal surgery despite advances in surgical techniques. This systematic review evaluates clinical outcomes associated with different anastomotic techniques and identifies evidence-based strategies for preventing AL. A comprehensive search identified 1,750 potential studies. Following rigorous screening based on methodological quality, relevance, and outcome reporting, 30 high-quality papers were selected for analysis. Studies included meta-analyses, randomized controlled trials, and well-designed observational studies published between 1980 and 2023. Meta-analyses were conducted for three key interventions using a random-effects model. AL incidence ranged from 3–19%, varying by anatomical location. No consistent differences in AL rates were found between stapled and hand-sewn anastomoses in most colorectal procedures, though stapled techniques demonstrated superiority in ileocolic surgery. Surgeon specialization significantly influenced outcomes with lower leak rates for colorectal specialists compared to general surgeons. Meta-analyses demonstrated that indocyanine green fluorescence angiography reduced AL risk by 55%, anastomotic reinforcement sutures by 58%, and polyglycolic acid sheets by 72%. Additional effective strategies included combined oral and intravenous antibiotic prophylaxis and multi-component perioperative care protocols. No single anastomotic technique demonstrates clear superiority across all colorectal procedures. The evidence supports a multifaceted approach to AL prevention incorporating surgical expertise, technical refinements, and optimized perioperative care. Future research should focus on standardizing techniques and validating emerging prevention strategies through large-scale trials.