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Low rectal anastomoses are associated with a substantial risk of anastomotic leakage. Tube caecostomy offers a potentially simple method of anastomotic protection.Some 226 patients undergoing restorative rectal resection with on-Table coloniclavage and tube caecostomy over an 11-year period were reviewed. Endpoints selected included clinical anastomotic leakage, requirement for a subsequent formal stoma and complications of tube caecostomy.Overall, clinical anastomotic leakage occurred in 25 patients with a caecostomy (11.1 per cent). All leaks were noted among patients in whom caecostomy protection had been used after low anterior resection, giving a leak rate of 14.9 per cent (25 of 168) for this group of whom 17 (10.1 per cent) required reoperation and a formal stoma, and five (3.0 per cent) died. Complications of caecostomy or prolonged drainage after tube removal occurred in ten (4.4 per cent) and 15 (6.6 per cent) patients respectively. There were two cases of life-threatening invasive infection.Tube caecostomy provides inadequate protection of rectal anastomoses; complications are common and may be life threatening.