Transanaal drainagesysteem vermindert darmobstructie na rectumcarcinoomresectie zonder verschil in anastomoselekage

BACKGROUND: Anastomotic leakage (AL) remains a significant postoperative concern in rectal cancer patients following anterior resection. This study aims to compare the effectiveness of a transanal drainage tube (TDT) versus a diverting stoma (DS) in reducing the incidence of this complication. METHODS: The systematic review was conducted following a comprehensive search of the PubMed, EMBASE, Web of Science, and Cochrane Library databases for all relevant studies published from inception to December 2025. For the meta-analyses, Review Manager 5.4 software was used, with a random-effects model applied as needed. RESULTS: A total of seven studies encompassing 1,347 participants were included in the analysis. Overall, no significant difference in the risk of AL was observed between the TDT and DS groups [odds ratio (OR) =0.73, 95% confidence interval (CI): 0.42 to 1.29, P=0.28]. Specifically, the TDT group exhibited a significantly lower incidence of bowel obstruction (OR =0.16, 95% CI: 0.08 to 0.32, P<0.01). Rates of other complications and postoperative length of stay were comparable between the two groups. CONCLUSIONS: Our findings indicate that no significant difference was observed between TDT and DS in reducing AL after anterior resection for rectal cancer. Notably, TDT use was associated with a significantly lower incidence of postoperative bowel obstruction. For selected patients, TDT may offer a strategy to avoid stoma-related complications and the need for reversal surgery.