Can a transanal tube help prevent leakage after rectal cancer surgery?

Key messages

In people undergoing surgery for rectal cancer:

• Using a soft tube (transanal tube) placed through the anus (end of the bowel where stools come out) may reduce the need for further surgery due to bowel leakage. However, it is uncertain whether the tube reduces the chance of leakage itself.

• This finding changed according to whether people had a temporary opening in the bowel (a diverting stoma). Among people with a diverting stoma, leakage was more frequent with a transanal tube than without one.

• More research is needed to identify which people are most likely to benefit from a transanal tube and to better understand the possible benefits and risks.

What is anastomotic leakage?

After rectal cancer surgery, the surgeon needs to reconnect the bowel. This connection is called anastomosis. Sometimes the anastomosis does not heal properly, allowing bowel contents to leak into the abdomen. This is called anastomotic leakage. It can cause a serious infection and make recovery more difficult.

How can leakage be prevented?

One common way to help prevent leakage is by creating a temporary opening in the bowel, called a diverting stoma. This allows stool to leave the body without passing through the healing bowel connection. However, a diverting stoma can lead to complications and requires another operation to close it.

Another option is placing a soft tube through the anus so that it lies near the bowel connection. This is called a transanal tube. The tube may reduce pressure, improve drainage, and help reduce the risk of leakage.

What did we want to find out?

We wanted to find out whether using a transanal tube during rectal cancer surgery:

• lowers the risk of anastomotic leakage;

• lowers the need for further surgery;

• causes any unwanted effects or other problems.

What did we do?
We searched for studies that compared using a transanal tube with not using one in adults undergoing rectal cancer surgery. We compared and summarised the results of the studies and assessed how confident we were in the evidence.

What did we find?

We found four studies involving 1318 people undergoing rectal cancer surgery. About half had a transanal tube placed during surgery, and the others did not. Studies took place in Denmark, Japan and China and most lasted up to 30 days after surgery. One study did not use a diverting stoma. Different types of tube were used, and they were put in place for 3 to 7 days. Different types of surgery were also used.

Main results

Compared with not using a tube, it is uncertain whether a transanal tube lowers the chance of leakage (4 studies, 1318 people). For every 1000 people having surgery, the risk of anastomotic leakage would be 83 in those without a tube compared to 73 with a tube. However:

• It may reduce the need for further surgery to treat leakage (3 studies, 1124 people). For every 1000 people having surgery, the risk of further surgery would be 45 in those without a tube compared to 14 in those with a tube;

• It may reduce the length of hospital stay after surgery, although this finding was based on one study with 398 people. Those who had a transanal tube placed were discharged from hospital an average of 3.25 days earlier than those without a tube;

• It may cause other problems, such as pain or discomfort, but the evidence is unclear. About 1 in 4 people reported pain or discomfort, and a few had the tube come out earlier than planned.

• The results for leakage changed according to whether people had a diverting stoma. Among people with a diverting stoma, leakage was more frequent with a transanal tube than without one.

What are the limitations of the evidence?

The studies were generally small, and the results varied between studies. Some studies also had limitations in how they were conducted or reported. Because of this, we are not confident about many of the results, and more research is needed to better understand which people are most likely to benefit from a transanal tube and its possible unwanted effects.

How up to date is this evidence?

The evidence is current to 6 August 2025.