The Safety of Primary Anastomosis Without Protective Stoma in Emergency Left Colon Surgery: A Meta-Analysis

This study aims to evaluate the safety of primary anastomosis (PA) without a protective stoma in emergency left colon surgery.

A systematic search was conducted in the PubMed, Web of Science, Embase, and Cochrane Library databases, covering articles from the inception of these databases until September 2024. The primary outcome was the incidence of anastomotic leakage.

The PA group exhibited a higher incidence of anastomotic leakage compared to the stoma surgery group (odds ratios (OR) = 5.86, p = 0.05). However, in cases of perforated diverticulitis (OR = 3.80, p = 0.19) and malignant obstruction (OR = 5.40, p = 0.23), the PA group did not show an increased risk of anastomotic leakage. In terms of other outcomes, the reoperation rate in the PA group was higher compared to the stoma surgery group (OR = 1.89, p < 0.001). However, there were no statistically significant differences in the mortality rate (OR = 1.04, p = 0.80) or the incidence of postoperative complications (OR = 1.50, p = 0.27) between the two groups.

Primary anastomosis without a protective stoma is generally safe and can be considered a viable option in emergency left colon surgery.