Smoking Cessation Recommendations to Reduce Anastomotic Leak Risk

Risk Factor Evidence

• Smoking is a significant, modifiable risk factor for gastrointestinal anastomotic leak, and patients should cease smoking at least 4 weeks before elective surgery – supported by high‑quality evidence and a strong recommendation from the Enhanced Recovery After Surgery (ERAS) Society guidelines. 1

Guideline Recommendations

• The ERAS Society recommends a minimum of 4 weeks of pre‑operative smoking cessation to lower the incidence of postoperative pulmonary and wound complications, including anastomotic leak; this is classified as a strong recommendation based on high‑quality evidence. 1

Disease‑Specific Guidance

• The British Society of Gastroenterology issues a strong recommendation that all patients who smoke after intestinal resection for Crohn’s disease be actively encouraged to stop, drawing on moderate‑quality evidence. 2