Background and objective: Whether selective defunctioning stoma could reduce the rate of anastomotic leak and lessen adverse effects in low anterior resection (LAR) remains controversial. This study was to evaluate the necessity of selective defunctioning stoma after LAR.

Methods: Medline databases were searched and English-language articles regarding to selective defunctioning stoma in LAR published from January 1, 1990 to October 1, 2007 were acquired. Seven literatures from seven different studies were included in this study, with total enrollment of 5040 patient. The rate of anastomotic leakage and re-operation rate in different surgical procedures (with or without selective defunctioning stoma) were pooled to compare using meta-analysis.

Results: Selective defunctioning stoma did not significantly reduce the rate of anastomotic leakage after LAR. The pooled odds ratio (OR) was 0.68 (95%CI=0.45-1.02, P>0.05). Selective defunctioning stoma significantly reduced the rate of surgery-required anastomotic leakage following LAR. The pooled OR was 0.33(95% CI=0.25-0.44, P<0.01).

Conclusion: Although selective defunctioning stoma does not reduce the rate of anastomotic leakage, it reduces the rate of surgery-required anastomotic leakage.