Shi XL, Cai LS, Zhang LJ, Zhang L. Preventive drainage and anastomotic leakage after colorectal surgery. World J Gastrointest Surg 2026; 18(9): 123355 [DOI: 10.4240/wjgs.123355]
Corresponding Author of This Article
Li Zhang, MD, Department of Colorectal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. tension1000@126.com
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Surgery
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research-article
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Shi XL, Cai LS, Zhang LJ, Zhang L. Preventive drainage and anastomotic leakage after colorectal surgery. World J Gastrointest Surg 2026; 18(9): 123355 [DOI: 10.4240/wjgs.123355]
World J Gastrointest Surg. Sep 27, 2026; 18(9): 123355 Published online Sep 27, 2026. doi: 10.4240/wjgs.123355
Preventive drainage and anastomotic leakage after colorectal surgery
Xia-Ling Shi, Long-Sheng Cai, Ling-Jie Zhang, Li Zhang
Xia-Ling Shi, Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
Long-Sheng Cai, Department of Ophthalmology, Longchuan County People’s Hospital, Heyuan 517300, Guangdong Province, China
Ling-Jie Zhang, Department of Traditional Chinese Medicine, Longchuan County People’s Hospital, Heyuan 517300, Guangdong Province, China
Li Zhang, Department of Colorectal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Co-first authors: Xia-Ling Shi and Long-Sheng Cai.
Co-corresponding authors: Ling-Jie Zhang and Li Zhang.
Author contributions: Shi XL, Cai LS, Zhang LJ, and Zhang L contributed to the investigation; Shi XL and Zhang L contributed to the conceptualization, writing of the original draft, and review and editing; Shi XL and Cai LS contributed to the writing; Cai LS, Zhang LJ, and Zhang L contributed to the methodology; Zhang LJ and Zhang L contributed to the resources; Cai LS contributed to the validation, formal analysis, data curation, software, and visualization; All authors approved the final version to publish. Shi XL and Cai LS contributed equally as co-first authors. Zhang LJ and Zhang L contributed equally as co-corresponding authors.
AI contribution statement: Portions of this manuscript were edited using artificial intelligence tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Li Zhang, MD, Department of Colorectal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. tension1000@126.com
Received: May 18, 2026 Revised: June 30, 2026 Accepted: July 31, 2026 Published online: September 27, 2026 Processing time: 122 Days and 0.1 Hours
Abstract
BACKGROUND
Anastomotic leakage is a serious complication following colorectal surgery, associated with increased morbidity, reoperation, and poor long-term outcomes. Although preventive drainage is widely used, its effectiveness remains controversial. Previous meta-analyses have generally pooled data across different drainage modalities, potentially obscuring modality-specific effects. We hypothesized that the association between preventive drainage and anastomotic leakage varies by drainage modality.
AIM
To evaluate the association between preventive drainage modalities and postoperative anastomotic leakage after colorectal surgery.
METHODS
A systematic review and meta-analysis was conducted using PubMed and Web of Science databases up to April 25, 2026. Comparative studies evaluating preventive drainage vs no drainage following colorectal surgery were included. The primary outcome was postoperative anastomotic leakage. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using random-effects models. Subgroup analyses were performed according to drainage modality, and sensitivity and publication bias analyses were conducted.
RESULTS
Thirty-six studies (38 comparisons) involving 17690 patients were included. Preventive drainage was associated with a lower risk of anastomotic leakage than no drainage (RRs = 0.67, 95%CI: 0.54-0.83). Transanal drainage significantly reduced leakage risk (RRs = 0.58, 95%CI: 0.45-0.74), whereas pelvic drainage showed no significant benefit (RRs = 0.80, 95%CI: 0.53-1.19). Other drainage methods were also not associated with a significant reduction in leakage risk (RRs = 1.38, 95%CI: 0.89-2.13). Subgroup differences were significant (P = 0.0026). Sensitivity analyses showed stable results, with pooled RRs ranging from 0.65 to 0.69 after sequential study exclusion. Begg’s test showed no significant publication bias (P = 0.0576).
CONCLUSION
Preventive drainage is associated with reduced anastomotic leakage following colorectal surgery, primarily mediated by transanal drainage; the benefits of other drainage modalities remain unproven.
Core Tip: This meta-analysis evaluated whether preventive drainage reduces anastomotic leakage after colorectal surgery and stratified outcomes by drainage modality. Thirty-six studies comprising 17690 patients were included. The overall reduction in leakage risk was primarily driven by transanal drainage. Pelvic drainage and other drainage methods showed no statistically significant preventive effect. These findings suggest that preventive drainage should not be considered a uniform strategy, and that the choice of modality should be based on drainage modality, anastomotic level, operative setting, and patient risk.
