PURPOSE:The aim of this study was to investigate the role of omentoplasty, by means of intact omentum, in preventing anastomotic leakages after rectal resection.METHODS:Between 1992 and 1997 a total of 112 patients (64 males) with a mean age of 64.7 (range, 39‐83) years were randomly assigned to undergo omentoplasty (Group A) or not (Group B) to reinforce the colorectal anastomosis after anterior resection for rectal cancer. The primary end point was anastomotic leakage; the secondary end point included morbility and mortality related to omentoplasty.RESULTS:The two groups were comparable in terms of preoperative and intraoperative characteristics. Staple‐ring disruption at plain abdominal radiographs was detected in seven instances in Group A and in ten in Group B patients (P= not significant). Two leakages were evident clinically in Group A and seven in Group B (P<0.05). Three leaks were documented radiologically in Group A and eight in Group B (P= not significant). No complications related to omentoplasty were observed in Group A. There were two repeat operations for anastomotic leakage in Group B. At follow‐up, one stricture developed in Group A and three in Group B (P= not significant)CONCLUSIONS:Despite a similar incidence of staple‐ring defects, a strikingly lower rate of clinically and radiologically detected leaks developed in patients submitted to omentoplasty. Although not affecting the incidence of anastomotic disruption, omentoplasty seems to contain the severity of anastomotic leakage.