Bridging the gap: a systematic literature review and meta-analysis on the management of rectal wall defect after transanal excision.

S Vaghiri, E Gorgun, H Kessler, W T Knoefel, D Prassas

Abstract readSystematic ReviewMeta-Analysis

In one paragraph

Synthesis in Techniques in coloproctology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

S VaghiriDepartment of Surgery (A), Heinrich-Heine-University, Medical Faculty and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.

E GorgunDepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.

H KesslerDepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.

W T KnoefelDepartment of Surgery (A), Heinrich-Heine-University, Medical Faculty and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.

D PrassasDepartment of Surgery (A), Heinrich-Heine-University, Medical Faculty and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. Dimitrios.Prassas@med.uni-duesseldorf.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTransanal resection techniques have gained considerable importance in the treatment of benign and malignant rectal neoplasms. However, there is no definitive consensus on whether the rectal defect should be closed or left open after excision. We sought to provide an updated pooled analysis of the management of rectal wall defect after transanal excision.

methodsIn accordance with PRISMA and Cochrane guidelines, this meta-analysis was performed using the PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Google Scholar databases to identify studies comparing perioperative outcomes after rectal defect closure versus leaving the defect open following full-thickness (FT) excision. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using Cochrane's Q test. Risk of bias and certainty of evidence were judged by ROBINS-I and GRADE, respectively.

resultsSix comparative studies meeting the inclusion criteria were included in the final analysis. Closing the rectal defect was associated with significantly reduced rectal bleeding (OR = 0.57, 95% CI: 0.35-0.94, p = 0.03; I

conclusionsThe present analysis revealed that both approaches are safe and technically feasible; however, closing the rectal wall defect after FT excision of rectal neoplasms was associated with lower bleeding and re-admission rates. Nevertheless, randomized studies with homogeneous protocols and consistent long-term outcome data are still needed to provide definitive answers.

Indexed as

Postoperative ComplicationsProctectomyRectal NeoplasmsRectumTransanal Endoscopic SurgeryWound Closure TechniquesAnal CanalColorectal Surgical ProceduresHumansPostoperative HemorrhageTreatment OutcomeDefect closurePostoperative morbidityRectal excisionTAMISTEMTransanal surgery

Identifiers

PMID42141324

DOI10.1007/s10151-026-03342-4

PMCPMC13179188

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