Novel adjunctive technologies for the prevention of colorectal anastomotic leakage: a systematic review

Anastomotic leakage (AL) remains one of the most serious complications following colorectal surgery, particularly after low anterior resection. In recent years, several adjunctive technologies have been introduced to reinforce anastomotic integrity during the early phases of healing. This systematic review aimed to evaluate the safety, feasibility, and clinical effectiveness of novel mechanical and biological devices designed to prevent AL in colorectal surgery.

A systematic literature search was conducted in PubMed, Embase, and Scopus. Human studies evaluating innovative adjunctive devices for AL prevention in patients undergoing low anterior resection were included. Studies focusing on transanal tubes, omental wrapping, or suture reinforcement were excluded. The primary outcome was the rate of anastomotic leakage.

Eighteen studies published between 2005 and 2021 met the inclusion criteria. The evaluated technologies were grouped into six categories: bioabsorbable staple-line reinforcements, nitinol-based compression rings, biodegradable intraluminal sheaths, vacuum-anchored diversion systems, fi brin-based sealants, and collagen patches (Seamguard™, C-Seal™, ColonRing™, Colovac™, Tissucol™/Greenplast™, TachoSil™, and Hemopatch™). Considerable heterogeneity in study design and methodological quality was observed. Although several devices demonstrated acceptable technical feasibility and safety, their eff ect on AL prevention was inconsistent. Only a limited number of studies included control groups or were designed as randomized controlled trials. Device-related complications, including migration, technical difficulties, and local tissue reactions, were reported in some series.

Current adjunctive technologies have not consistently demonstrated a reduction in AL rates after colorectal surgery. While selected devices may provide potential benefit in high-risk patients, their clinical applicability remains limited by technical constraints and heterogeneous evidence. Further large, high-quality studies incorporating standardized definitions of AL and patient-specific risk stratification are warranted.