Closing rectal wall defects after full-thickness excision reduces bleeding and re-admission rates compared to leaving defects open in patients with rectal neoplasms

Photo by Navy Medicine / Unsplash

Techniques in coloproctology Published May 16, 2026 Medically reviewed May 16, 2026 Study authors: Vaghiri S, Gorgun E, Kessler H, Knoefel W T, Prassas D PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Closing rectal wall defects after full-thickness excision reduces bleeding and re-admission rates compared to leaving defects open, with both methods remaining safe.

This systematic literature review and meta-analysis evaluated six comparative studies involving patients undergoing full-thickness excision of rectal neoplasms. The primary comparison focused on closing the rectal wall defect versus leaving the defect open. No randomized studies with homogeneous protocols and consistent long-term outcome data were available at the time of analysis.

results indicated that closing the defect significantly reduced rectal bleeding, with an odds ratio of 0.57 and a p-value of 0.03. Re-admission rates also dropped substantially, showing an odds ratio of 0.34 and a p-value of 0.008. However, the procedure requiring closure did prolong operative time, with a standardized mean difference of 0.15 and a p-value of 0.02.

Safety profiles were not explicitly detailed in the included reports, but the practice relevance suggests both techniques are safe. The authors emphasize that while closing defects offers clear benefits regarding bleeding and readmissions, further research is needed to confirm long-term outcomes with randomized trials.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID42141324

View Original Abstract ↓

BACKGROUND: Transanal resection techniques have gained considerable importance in the treatment of benign and malignant rectal neoplasms. However, there is no definitive consensus on whether the rectal defect should be closed or left open after excision. We sought to provide an updated pooled analysis of the management of rectal wall defect after transanal excision. METHODS: In accordance with PRISMA and Cochrane guidelines, this meta-analysis was performed using the PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Google Scholar databases to identify studies comparing perioperative outcomes after rectal defect closure versus leaving the defect open following full-thickness (FT) excision. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using Cochrane's Q test. Risk of bias and certainty of evidence were judged by ROBINS-I and GRADE, respectively. RESULTS: Six comparative studies meeting the inclusion criteria were included in the final analysis. Closing the rectal defect was associated with significantly reduced rectal bleeding (OR = 0.57, 95% CI: 0.35-0.94, p = 0.03; I = 26%) and re-admission rates (OR = 0.34, 95% CI: 0.16-0.76, p = 0.008; I = 0%) compared with the open group, while other outcomes were not significantly different. A prolonged operative time was noted when the rectal wall defect was sutured (SMD = 0.15, 95% CI: 0.03-0.28, p = 0.02; I = 44%). CONCLUSIONS: The present analysis revealed that both approaches are safe and technically feasible; however, closing the rectal wall defect after FT excision of rectal neoplasms was associated with lower bleeding and re-admission rates. Nevertheless, randomized studies with homogeneous protocols and consistent long-term outcome data are still needed to provide definitive answers.