Integrated intraoperative strategies to prevent anastomotic leakage after laparoscopic low anterior resection: The roles of left colic artery preservation, reinforcement suturing, and transanal tube placement

Anastomotic leakage is a major complication following laparoscopic low anterior resection in patients with low rectal cancer. This study investigated the preventive effects of three intraoperative techniques, including the preservation of the left colic artery, reinforcement suturing, and transanal decompression tube placement. A total of 88 patients undergoing laparoscopic rectal cancer surgery were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to assess the associations between these interventions and the occurrence of anastomotic leakage. The overall anastomotic leakage rate was 7.95%. Left colic artery preservation, reinforcement suturing, and transanal decompression tube placement each showed a lower anastomotic leakage incidence (5.3%, 6.3%, and 7.4%, respectively) compared with nonapplication. The combined use of all three measures resulted in zero anastomotic leakage. Multivariate analysis confirmed a consistent protective trend, with left colic artery preservation demonstrating the strongest effect. Preserving the left colic artery, reinforcing the anastomosis, and reducing intraluminal pressure act synergistically to reduce the risk of anastomotic leakage. Their integrated use may offer an effective strategy to enhance anastomotic safety in rectal surgery.