Reinforcement suturing and preventive stomas had similar observed leak rates after rectal resection

Anastomotic leakage is a serious complication after low anterior resection for rectal cancer. This multicenter retrospective study included 345 patients who underwent laparoscopic surgery between January 2022 and December 2023. It compared reinforcement suturing with preventive stoma formation, with 30-day leakage as the primary outcome. The investigators also examined perioperative factors, anastomotic height subgroups and postoperative hospitalization outcomes.

Overall, leakage occurred in 11 of 345 patients (3.19%). Before matching, rates were 3.07% (7/228) with reinforcement suturing and 3.42% (4/117) with a preventive stoma. In the matched groups of 72 patients each, leakage occurred in 5.6% (4/72) and 4.2% (3/72), respectively. The paired risk difference was 1.39 percentage points (95% CI, −5.56 to 8.33; exact McNemar P=1.000). All leaks were classified as ISREC grade C and Clavien–Dindo grade IIIb.

The authors report a low observed leak rate with reinforcement suturing in selected patients, which avoids planned stoma-related secondary surgery. However, the retrospective design and potential treatment-selection bias limit causal interpretation. The findings do not establish that suturing is equivalent to preventive stoma formation or support changing surgical practice.