Abstract Background: Anastomotic leak (AL) and stricture (AS) are major complications of colorectal surgery. This systematic review synthesizes evidence on risk factors, prevention strategies, and management. Methods: Comprehensive search of PubMed, Cochrane, Scopus, Embase, Web of Science (inception–July 2024). Meta-analysis using random-effects models with GRADE assessment. Study quality evaluated using MINORS and RoB 2 tools. Results: 66 studies included (11,560 patients). Risk factors for AL: male sex (OR 1.53, 95% CI 1.23–1.91), low rectal location 30 kg/m². Intraoperative perfusion assessment significantly reduced AL rates (7.4% vs 12.4%, p<0.01). Indocyanine green fluorescence angiography (ICG-FA) demonstrated strongest evidence (OR 0.586, 95% CI 0.434–0.792, NNT=21). Endoscopic salvage techniques proved effective: vacuum-assisted closure (88.8% success), over-the-scope clips (57–100%), self-expanding metal stents (50–100%) in hemodynamically stable patients. Anastomotic stricture incidence: 17% (95% CI 13–21%), with risk factors including protective stoma (OR 2.88), anastomotic leak (OR 3.72), radiotherapy (OR 2.43), and low location (WMD −3.11 cm). Mechanical anastomosis was protective (OR 0.39). Conclusions: Intraoperative perfusion assessment with ICG-FA reduces leak rates (moderate-certainty evidence). Endoscopic salvage is safe and effective in selected patients. Multiple risk factors require individualized prevention strategies. Keywords: anastomotic leak, anastomotic stricture, colorectal surgery, perfusion imaging, indocyanine green, meta-analysis, risk factors
Lemańska et al. (Wed,) studied this question.