Emile Sameh Hany, Oslin Roberta Lynn, Wignakumar Anjelli, Horesh Nir, Garoufalia Zoe, Wexner Steven D, Boutros Marylise
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA.
Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Colorectal Dis. 2025 Aug;27(8):e70186. doi: 10.1111/codi.70186.
Anastomotic leak (AL) after colorectal anastomosis can be a risk factor for bowel dysfunction, namely low anterior resection syndrome (LARS). The present study aimed to assess bowel dysfunction in patients who developed AL after anterior resection compared to patients without AL.
We conducted a PRISMA-compliant systematic review of PubMed, Scopus and Cochrane Library for randomized and observational studies investigating the association between AL after anterior resection and bowel dysfunction. The main outcomes were LARS, faecal incontinence and urgency. Pairwise meta-analyses were conducted to calculate the relative risk (RR) of the study outcomes and their 95% confidence intervals (CI).
This review included 20 retrospective studies comprising 4764 patients (61.6% male, median age 63 years). AL was detected in 14% of patients and those who experienced AL had a higher risk of LARS (six studies; 1329 patients, RR: 1.27 95%CI: 1.02, 1.58, p = 0.035), major LARS (seven studies; 1395 patients, RR: 1.38, 95%CI: 1.07, 1.79, p = 0.012), urgency (five studies; 955 patients, RR: 1.15, 95%CI: 1.04, 1.27, p = 0.005) and had higher LARS scores (seven studies; 1450 patients, WMD: 6.64, 95%CI: 3.76, 9.52, p < 0.001) and Wexner incontinence scores (seven studies; 1045 patients, WMD: 1.72, 95%CI: 0.16, 3.28, p = 0.031).
Based on low to moderate certainty evidence, AL after colorectal and coloanal anastomoses was significantly associated with an increased risk of LARS, particularly major LARS, urgency and higher LARS and Wexner/Cleveland Clinic Florida-Fecal Incontinence Scores.
结直肠吻合术后吻合口漏（AL）可能是肠道功能障碍的危险因素，即低位前切除综合征（LARS）。本研究旨在评估前切除术后发生AL的患者与未发生AL的患者的肠道功能障碍情况。
我们对PubMed、Scopus和Cochrane图书馆进行了一项符合PRISMA标准的系统评价，纳入了调查前切除术后AL与肠道功能障碍之间关联的随机和观察性研究。主要结局为LARS、大便失禁和便急。进行成对荟萃分析以计算研究结局的相对风险（RR）及其95%置信区间（CI）。
本评价纳入了20项回顾性研究，共4764例患者（男性占61.6%，中位年龄63岁）。14%的患者检测到AL，发生AL的患者发生LARS的风险更高（6项研究；1329例患者，RR：1.27，95%CI：1.02，1.58，p = 0.035）、严重LARS（7项研究；1395例患者，RR：1.38，95%CI：1.07，1.79，p = 0.012）、便急（5项研究；955例患者，RR：1.15，95%CI：1.04，1.27，p = 0.005），且LARS评分更高（7项研究；1450例患者，WMD：6.64，95%CI：3.76，9.52，p < 0.001）以及韦克斯纳失禁评分更高（7项研究；1045例患者，WMD：1.72，95%CI：0.16，3.28，p = 0.031）。
基于低到中等确定性证据，结直肠和结肠肛管吻合术后的AL与LARS风险增加显著相关，尤其是严重LARS、便急以及更高的LARS和韦克斯纳/佛罗里达克利夫兰诊所大便失禁评分。
