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

Sep 22, 2026

Upload by Terk

Transanal resection techniques are increasingly used for benign and malignant rectal neoplasms, yet uncertainty remains about whether the rectal wall defect after excision should be closed or left open. This systematic review and meta-analysis pools perioperative evidence comparing defect closure versus open management after full-thickness excision. PRISMA and Cochrane methods guided database searching and risk assessment with ROBINS-I and GRADE. Six comparative studies were analyzed.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Materials and methods

Search strategy

Inclusion and exclusion criteria

Techniques in Coloproctology (2026) 30:65 [https://doi.org/10.1007/s10151-026-03342-4](https://doi.org/10.1007/s10151-026-03342-4) Bridging the gap: a systematic literature review and meta‑analysis on the management of rectal wall defect after transanal excision S. Vaghiri1 · E. Gorgun2 · H. Kessler2 · W. T. Knoefel1 · D. Prassas1,3 Received: 13 October 2025 / Accepted: 16 April 2026 © The Author(s) 2026 Abstract Background Transanal 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. Methods In 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. Results Six 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; I2 = 26%) and re-admission rates (OR = 0.34, 95% CI: 0 .16–0.76, p = 0.008; I2 = 0%) compared with the open group, while other outcomes were not significantly different. A prolonged operative time was noted when the rectal wall defect was sutured (SMD = 0.15, 95% CI: 0.03–0.28, p = 0.02; I2 = 44%) . Conclusions The 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. Keywords Transanal surgery · Rectal excision · Defect closure · Postoperative morbidity · TEM · TAMIS * D. Prassas [Dimitrios.Prassas@med.uni-duesseldorf.de](Dimitrios.Prassas@med.uni-duesseldorf.de) 1 Department of Surgery (A), Heinrich-Heine-University, Medical Faculty and University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany 2 Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA 3 Department of Surgery, Katholisches Klinikum Essen, Philippusstift, Teaching Hospital of Duisburg-Essen University, Huelsmannstr. 17, 45355 Essen, Germany Introduction Transanal excision of rectal neoplasms of the lower rectum has traditionally been performed via direct visualization of the lesion by using an anal retractor, such as the Parks retractor, and other conventional surgical apparatus. The concept of transanal endoscopic microsurgery (TEM) was first introduced by Buess four decades ago as an alternative to traditional local resection, greatly enhancing exposure and allowing access to more proximal rectal pathologies [1]. With the advent of minimally invasive surgery and laparoscopy, the concept of transanal minimally invasive surgery (TAMIS) emerged as a combination of TEM anda single-port approach and was first reported in 2010 [2] . All these advanced endoluminal platforms represented a giant leap forward, eliminating structural problems of the traditional Parks transanal excision and enabling improved quality of the resected specimens [3]. Nevertheless, a technically demanding step is common to all excisional methods: closure of the rectal defect. Closu

FAQs

What question does this meta-analysis address?

Whether closing the rectal wall defect after transanal excision is necessary, compared with leaving the defect open, following full-thickness excision.

Which guidelines and databases were used?

The analysis followed PRISMA and Cochrane guidance and searched PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Google Scholar.

What outcomes differed between closure and open management?

Rectal bleeding and re-admission rates were significantly lower with defect closure, while other outcomes were not significantly different; suturing was associated with a slightly longer operative time.

Sep 22, 2026

Upload by Terk