A novel pre–abdominal closure checklist in colorectal surgery serves as a critical defensive barrier against human errors

The use of a checklist during abdominal closure may reduce human error and improve surgical safety. To address this benefit, we evaluated the effectiveness of an institutional checklist by determining whether implementation led to additional procedures. A 12‑item pre‑closure checklist for colorectal surgery was developed and incorporated into practice in late May 2024. We retrospectively reviewed checklist findings documented in electronic medical records. Surgical outcomes were compared between 42 cases with and 409 cases without checklist use during 2020–2024. Of 45 patients, checklist information was unavailable for three. Among 42 remaining patients, additional intraoperative procedures were required in four cases following checklist use. Procedures included injury repair or hemostasis ( n = 1), application of antiadhesion agents ( n = 2), and repositioning of intestine or omentum to the original position ( n = 1). No incidents involving retained gauze, residual tissue, or deviations from planned procedures were identified. Among four cases requiring additional interventions, two involved multiple ancillary procedures and two required extended operative duration. No significant differences were observed between groups in anastomotic leakage, complication rate, or length of postoperative hospitalization. The pre-closure checklist facilitated the identification of intraoperative errors that otherwise might have been overlooked. Additional studies with a larger patient population, broader range of surgical procedures, and multiple institutions are needed to further clarify its utility.