术后吻合口漏出是直肠癌手术的一种主要并发症。本研究的主要目的是调查基于经肛门全直肠系膜切除术（TaTME）过程中四次手术中吻合检查（4-Check）的检测效果。回顾分析了进行经肛门全直肠系膜切除术治疗直肠癌的患者，并将其分为两组：在实施4-Check协议之前（pre-4-Check：2015年4月至2019年4月）和在实施4-Check协议之后（2019年5月至2022年5月）。此协议包括多模式吻合完整性评估，包括利用吲哚菁绿评估结肠残端和肠腔内吻合物灌注、反向漏气试验和吻合区域的圆环形检查。主要观察指标是临床和/或影像学吻合口漏出的发生率。次要观察指标包括术中吻合缺陷和修复情况以及术后30天并发症率。进行了配对分析和多变量分析。共有186名患者被选择，其中选择了160名患者：pre-4-Check组86名患者和4-Check组74名患者。经配对分析后，术后吻合漏出发生率没有差异（pre-4-Check组 versus 4-Check组：11.1% versus 7.4%；P = 0.50）。然而，在4-Check组中，术中吻合缺陷和修复的检测显著增加（P = 0.03），并且并发症发生率降低（pre-4-Check组 versus 4-Check组：33.3% versus 9.3%，P = 0.004）。多变量分析证实，采用4-Check协议、吻合缺陷的检测以及增高的白蛋白水平与并发症发生率降低相关。4-Check协议可以实现术中吻合缺陷的检测和修复。术后吻合漏出率没有降低，但实施该协议后术后30天的并发症发生率下降了。© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

Anastomotic leakage is a major complication following rectal cancer surgery. The primary aim of this study was to investigate the efficacy of a protocol based on a quadruple intraoperative anastomotic assessment (4-Check) during transanal total mesorectal excision (TaTME).Patients who underwent TaTME for rectal cancer with primary anastomosis were reviewed and divided into two groups: before (pre-4-Check: April 2015 - April 2019) and after the implementation of the 4-Check protocol (May 2019 - May 2022). This protocol consisted of a multimodal anastomotic integrity assessment, including indocyanine green-evaluation of colonic stump and intraluminal anastomosis perfusion, a reverse air leak test and anastomotic doughnuts assessment. The primary outcome was incidence of clinical and/or radiological anastomotic leakage. The secondary outcome included intraoperative anastomosis defects and repairs and 30-day complication rate. Propensity score matching and multivariable analyses were performed.Of 186 patients, 160 were selected: 86 patients in the pre-4-Check and 74 in the 4-Check group. After propensity score matching, there was no difference in postoperative anastomotic leakage (pre-4-Check versus 4-Check: 11.1 per cent versus 7.4 per cent; P = 0.50). However, in the 4-Check group, the intraoperative detection of defects and repairs was significantly increased (P = 0.03), and the number of complications was reduced (pre-4-Check versus 4-Check: 33.3 per cent versus 9.3 per cent, P = 0.004). Multivariable analyses confirmed that the use of the 4-Check protocol, the detection of anastomotic defects and increased albumin levels were associated with a reduced number of complications.The 4-Check protocol allowed the intraoperative detection and repair of anastomotic defects. Anastomotic leakage rates were not reduced; however, 30-day complication rates were lower after implementation of this protocol.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.