title: 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.
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.
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan. ohlkoh@gmail.com.|Department of Surgery, Saitama City Hospital, Saitama, Japan. ohlkoh@gmail.com.
authors.forename: Kohei
authors.initials: K
authors.lastname: Shigeta
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan. okabayashikoji@gmail.com.
authors.forename: Koji
authors.initials: K
authors.lastname: Okabayashi
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hasegawa
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Tsuruta
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamafuji
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kubochi
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000517:prevention & control*; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016017:Odds Ratio; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D017792:Surgical Stapling / Q000379:methods; D016896:Treatment Outcome
keywords: Anastomotic leakage; Anterior resection; Colorectal cancer; Transanal tube