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Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery

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Abstract

Introduction

The incidence of anastomotic leak (AL) has not decreased over the past decades and some important grey areas remain in its definition, prevention, and management. The aim of this study was to reach a national consensus on the definition of AL and to identify key points to be applied in clinical practice.

Methods

A 3-step modified Delphi method was used to establish consensus. Ten representative members of the major Italian surgical scientific societies with proven colorectal expertise were selected after a call to action. After a comprehensive literature search, each expert drew a list of evidence-based statements which were voted in round one by the scientific board. Panel members were asked to mark “totally disagree”, “partially agree” or “totally agree” for each statement and provide comments. The same voting method was used for round 2. Round 3 consisted of a final face-to-face meeting.

Results

Thirty-three statements (clustered into 14 topics) were included in round 1. Following the third voting round, a final list of 16 items was formulated, which encompass the following 9 topics: AL definition, patient- and operative-related risk factors, prevention measures, bowel preparation, surgical technique, intraoperative assessment, early diagnosis, radiological diagnosis and management of specific patterns of AL. The overall response rate was 100% for all items in all the three rounds.

Conclusions

This Delphi survey identified items that expert colorectal surgeons agreed were important to be applied in the prevention, diagnosis, and management of AL. This represents the first consensus involving all relevant national scientific societies, defining important and shared concepts in the diagnosis and management of AL.

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References

  1. Basilico V, Griffa B, Radaelli F et al (2014) Anastomotic leakage following colorectal resection for cancer: how to define, manage and treat it. Minerva Chir 69:245–252

    CAS  PubMed  Google Scholar 

  2. Frasson M, Flor-Lorente B, Rodríguez JLR et al (2015) Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients. Ann Surg 262:321–330. https://doi.org/10.1097/SLA.0000000000000973

    Article  PubMed  Google Scholar 

  3. Takahashi H, Haraguchi N, Nishimura J et al (2018) The severity of anastomotic leakage may negatively impact the long-term prognosis of colorectal cancer. Anticancer Res 38:533–539. https://doi.org/10.21873/anticanres.12255

    Article  PubMed  Google Scholar 

  4. Thomas MS, Margolin DA (2016) Management of colorectal anastomotic leak. Clin Colon Rectal Surg 29:138–144. https://doi.org/10.1055/s-0036-1580630

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vallance A, Wexner S, Berho M et al (2017) A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery. Colorectal Dis 19:O1–O12. https://doi.org/10.1111/codi.13534

    Article  CAS  PubMed  Google Scholar 

  6. van Rooijen SJ, Jongen AC, Wu Z-Q et al (2017) Definition of colorectal anastomotic leakage: a consensus survey among Dutch and Chinese colorectal surgeons. World J Gastroenterol 23:6172–6180. https://doi.org/10.3748/wjg.v23.i33.6172

    Article  PubMed  PubMed Central  Google Scholar 

  7. Prevention-diagnosis-and-management-of-colorectal-anastomotic-leakage-ASGBI-ACPGBI-2016.pdf (2018). https://www.acpgbi.org.uk/content/uploads/2017/02/Prevention-diagnosis-and-management-of-colorectal-anastomotic-leakage-ASGBI-ACPGBI-2016.pdf. Accessed 30 Jul 2018.

  8. Peel AL, Taylor EW (1991) Proposed definitions for the audit of postoperative infection: a discussion paper. Surgical Infection Study Group. Ann R Coll Surg Engl 73:385–388

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Bruce J, Krukowski ZH, Al-Khairy G et al (2001) Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88:1157–1168. https://doi.org/10.1046/j.0007-1323.2001.01829.x

    Article  CAS  PubMed  Google Scholar 

  10. Olsen BC, Sakkestad ST, Pfeffer F, Karliczek A (2018) Rate of anastomotic leakage after rectal anastomosis depends on the definition: pelvic abscesses are significant. Scand J Surg. https://doi.org/10.1177/1457496918812223

    Article  PubMed  Google Scholar 

  11. Daniel VT, Alavi K, Davids JS et al (2019) The utility of the delphi method in defining anastomotic leak following colorectal surgery. Am J Surg. https://doi.org/10.1016/j.amjsurg.2019.05.011

    Article  PubMed  Google Scholar 

  12. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351. https://doi.org/10.1016/j.surg.2009.10.012

    Article  PubMed  Google Scholar 

  13. Kulu Y, Ulrich A, Bruckner T et al (2013) Validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage. Surgery 153:753–761. https://doi.org/10.1016/j.surg.2013.02.007

    Article  PubMed  Google Scholar 

  14. McDermott FD, Heeney A, Kelly ME et al (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102:462–479. https://doi.org/10.1002/bjs.9697

    Article  CAS  PubMed  Google Scholar 

  15. Phitayakorn R, Delaney CP, Reynolds HL et al (2008) Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg 32:1147–1156. https://doi.org/10.1007/s00268-008-9468-1

    Article  CAS  PubMed  Google Scholar 

  16. Moghadamyeghaneh Z, Hanna MH, Alizadeh RF et al (2016) Contemporary management of anastomotic leak after colon surgery: assessing the need for reoperation. Am J Surg 211:1005–1013. https://doi.org/10.1016/j.amjsurg.2015.07.025

    Article  PubMed  Google Scholar 

  17. Vu L, Penter C, Platell C (2019) Long-term significance of an anastomotic leak in patients undergoing an ultra-low anterior resection for rectal cancer. ANZ J Surg. https://doi.org/10.1111/ans.15373

    Article  PubMed  Google Scholar 

  18. Gustafsson UO, Scott MJ, Hubner M et al (2019) Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. World J Surg 43:659–695. https://doi.org/10.1007/s00268-018-4844-y

    Article  CAS  PubMed  Google Scholar 

  19. Murphy MK, Black NA, Lamping DL et al (1998) Consensus development methods, and their use in clinical guideline development. Health Technol Assess 2:1–88

    Google Scholar 

  20. Manuale_PNLG.1234439852.pdf (2020). https://old.iss.it/binary/lgmr2/cont/Manuale_PNLG.1234439852.pdf. Accessed 25 May 2020.

  21. Manuale-Metodologico-Consensus.pdf (2020). https://www.psy.it/wp-content/uploads/2018/02/Manuale-Metodologico-Consensus.pdf. Accessed 25 May 2020.

  22. Grewal A, Kataria H, Dhawan I (2016) Literature search for research planning and identification of research problem. Indian J Anaesth 60:635–639. https://doi.org/10.4103/0019-5049.190618

    Article  PubMed  PubMed Central  Google Scholar 

  23. Oxman AD, Sackett DL, Guyatt GH (1993) Users’ guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA 270:2093–2095

    Article  CAS  PubMed  Google Scholar 

  24. Dekker JWT, Liefers GJ, van Otterloo JCA et al (2011) Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score. J Surg Res 166:e27–34. https://doi.org/10.1016/j.jss.2010.11.004

    Article  PubMed  Google Scholar 

  25. Lubitz AL, Chan E, Zarif D et al (2017) American College of Surgeons NSQIP risk calculator accuracy for emergent and elective colorectal operations. J Am Coll Surg 225:601–611. https://doi.org/10.1016/j.jamcollsurg.2017.07.1069

    Article  PubMed  Google Scholar 

  26. Sammour T, Cohen L, Karunatillake AI et al (2017) Validation of an online risk calculator for the prediction of anastomotic leak after colon cancer surgery and preliminary exploration of artificial intelligence-based analytics. Tech Coloproctol 21:869–877. https://doi.org/10.1007/s10151-017-1701-1

    Article  CAS  PubMed  Google Scholar 

  27. Arezzo A, Migliore M, Chiaro P et al (2019) The REAL (REctal Anastomotic Leak) score for prediction of anastomotic leak after rectal cancer surgery. Tech Coloproctol. https://doi.org/10.1007/s10151-019-02028-4

    Article  PubMed  Google Scholar 

  28. Weimann A, Braga M, Harsanyi L et al (2006) ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr 25:224–244. https://doi.org/10.1016/j.clnu.2006.01.015

    Article  CAS  PubMed  Google Scholar 

  29. Skipper A, Ferguson M, Thompson K et al (2012) Nutrition screening tools: an analysis of the evidence. JPEN J Parenter Enteral Nutr 36:292–298. https://doi.org/10.1177/0148607111414023

    Article  PubMed  Google Scholar 

  30. Weimann A, Braga M, Carli F et al (2017) ESPEN guideline: clinical nutrition in surgery. Clin Nutr 36:623–650. https://doi.org/10.1016/j.clnu.2017.02.013

    Article  PubMed  Google Scholar 

  31. Chambrier C, Sztark F, Société Francophone de nutrition clinique et métabolisme (SFNEP), Société française d’anesthésie et réanimation (SFAR) (2012) French clinical guidelines on perioperative nutrition. Update of the 1994 consensus conference on perioperative artificial nutrition for elective surgery in adults. J Visc Surg 149:e325–336. https://doi.org/10.1016/j.jviscsurg.2012.06.006

    Article  CAS  PubMed  Google Scholar 

  32. August DA, Huhmann MB, American Society for Parenteral, and Enteral Nutrition (A.S.P.E.N.) Board of Directors (2009) A.S.P.E.N clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr 33:472–500. https://doi.org/10.1177/0148607109341804

    Article  PubMed  Google Scholar 

  33. Caccialanza R, Lobascio F, Cereda E et al (2020) Cancer-related malnutrition management: A survey among Italian Oncology Units and Patients’ Associations. Curr Probl Cancer. https://doi.org/10.1016/j.currproblcancer.2020.100554

    Article  PubMed  Google Scholar 

  34. Contant CME, vant HopSant WCJHP et al (2007) Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 370:2112–2117. https://doi.org/10.1016/S0140-6736(07)61905-9

    Article  PubMed  Google Scholar 

  35. Slim K, Vicaut E, Launay-Savary M-V et al (2009) Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 249:203–209. https://doi.org/10.1097/SLA.0b013e318193425a

    Article  PubMed  Google Scholar 

  36. Scarborough JE, Mantyh CR, Sun Z, Migaly J (2015) Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of Colectomy-targeted ACS NSQIP. Ann Surg 262:331–337. https://doi.org/10.1097/SLA.0000000000001041

    Article  PubMed  Google Scholar 

  37. Kiran RP, Murray ACA, Chiuzan C et al (2015) Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 262:416–425. https://doi.org/10.1097/SLA.0000000000001416

    Article  PubMed  Google Scholar 

  38. Althumairi AA, Canner JK, Pawlik TM et al (2016) Benefits of bowel preparation beyond surgical site infection: a retrospective study. Ann Surg 264:1051–1057. https://doi.org/10.1097/SLA.0000000000001576

    Article  PubMed  Google Scholar 

  39. Fry DE (2019) Review of the American Society of Colon and Rectal Surgeons clinical practice guidelines for the use of bowel preparation in elective colon and rectal surgery. JAMA Surg. https://doi.org/10.1001/jamasurg.2019.4551

    Article  PubMed  Google Scholar 

  40. Garfinkle R, Abou-Khalil J, Morin N et al (2017) Is there a role for oral antibiotic preparation alone before colorectal surgery? ACS-NSQIP analysis by coarsened exact matching. Dis Colon Rectum 60:729–737. https://doi.org/10.1097/DCR.0000000000000851

    Article  PubMed  Google Scholar 

  41. Koller SE, Bauer KW, Egleston BL et al (2018) Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. Ann Surg 267:734–742. https://doi.org/10.1097/SLA.0000000000002159

    Article  PubMed  Google Scholar 

  42. Devane LA, Proud D, O’Connell PR, Panis Y (2017) A European survey of bowel preparation in colorectal surgery. Colorectal Dis 19:O402–O406. https://doi.org/10.1111/codi.13905

    Article  CAS  PubMed  Google Scholar 

  43. Koskenvuo L, Lehtonen T, Koskensalo S et al (2019) Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial. Lancet 394:840–848. https://doi.org/10.1016/S0140-6736(19)31269-3

    Article  CAS  PubMed  Google Scholar 

  44. Suzuki T, Sadahiro S, Tanaka A et al (2020) Usefulness of preoperative mechanical bowel preparation in patients with colon cancer who undergo elective surgery: a prospective randomized trial using oral antibiotics. Dig Surg 37:192–198. https://doi.org/10.1159/000500020

    Article  CAS  PubMed  Google Scholar 

  45. Hata H, Yamaguchi T, Hasegawa S et al (2016) Oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (JMTO PREV 07–01): a phase 3, multicenter, open-label, randomized trial. Ann Surg 263:1085–1091. https://doi.org/10.1097/SLA.0000000000001581

    Article  PubMed  Google Scholar 

  46. WHO SSI prevention guidelines appendix6.pdf (2020). https://www.who.int/gpsc/appendix6.pdf. Accessed 25 May 2020.

  47. Alverdy JC, Hyman N, Gilbert J et al (2017) Preparing the bowel for surgery: learning from the past and planning for the future. J Am Coll Surg 225:324–332. https://doi.org/10.1016/j.jamcollsurg.2017.05.005

    Article  PubMed  PubMed Central  Google Scholar 

  48. Neutzling CB, Lustosa SAS, Proenca IM et al (2012) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003144.pub2

    Article  PubMed  Google Scholar 

  49. Naumann DN, Bhangu A, Kelly M, Bowley DM (2015) Stapled versus handsewn intestinal anastomosis in emergency laparotomy: a systemic review and meta-analysis. Surgery 157:609–618. https://doi.org/10.1016/j.surg.2014.09.030

    Article  PubMed  Google Scholar 

  50. European Society of Coloproctology collaborating group (2017) The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit. Colorectal Dis. https://doi.org/10.1111/codi.13646

    Article  Google Scholar 

  51. ESCP Cohort Studies and Audits Committee (2018) The 2017 European Society of Coloproctology (ESCP) international snapshot audit of left colon, sigmoid and rectal resections - study protocol. Colorectal Dis 20(Suppl 6):5–12. https://doi.org/10.1111/codi.14377

    Article  Google Scholar 

  52. Collopy BT (2001) Colorectal anastomotic leak rates are measures of technical skill in surgery. ANZ J Surg 71:508–510. https://doi.org/10.1046/j.1440-1622.2001.02181.x

    Article  CAS  PubMed  Google Scholar 

  53. Offodile AC, Feingold DL, Nasar A et al (2010) High incidence of technical errors involving the EEA circular stapler: a single institution experience. J Am Coll Surg 210:331–335. https://doi.org/10.1016/j.jamcollsurg.2009.11.007

    Article  PubMed  Google Scholar 

  54. Blanco-Colino R, Espin-Basany E (2018) Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 22:15–23. https://doi.org/10.1007/s10151-017-1731-8

    Article  CAS  PubMed  Google Scholar 

  55. Degett TH, Andersen HS, Gögenur I (2016) Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbecks Arch Surg 401:767–775. https://doi.org/10.1007/s00423-016-1400-9

    Article  PubMed  Google Scholar 

  56. James DRC, Ris F, Yeung TM et al (2015) Fluorescence angiography in laparoscopic low rectal and anorectal anastomoses with pinpoint perfusion imaging–a critical appraisal with specific focus on leak risk reduction. Colorectal Dis 17(Suppl 3):16–21. https://doi.org/10.1111/codi.13033

    Article  PubMed  Google Scholar 

  57. Mangano A, Gheza F, Chen LL et al (2018) Indocyanine Green (Icg)-enhanced fluorescence for intraoperative assessment of bowel microperfusion during laparoscopic and robotic colorectal surgery: the quest for evidence-based results. Surg Technol Int 32:101–104

    PubMed  Google Scholar 

  58. Shen R, Zhang Y, Wang T (2018) Indocyanine green fluorescence angiography and the incidence of anastomotic leak after colorectal resection for colorectal cancer: a meta-analysis. Dis Colon Rectum 61:1228–1234. https://doi.org/10.1097/DCR.0000000000001123

    Article  PubMed  Google Scholar 

  59. van den Bos J, Al-Taher M, Schols RM et al (2018) Near-infrared fluorescence imaging for real-time intraoperative guidance in anastomotic colorectal surgery: a systematic review of literature. J Laparoendosc Adv Surg Tech A 28:157–167. https://doi.org/10.1089/lap.2017.0231

    Article  PubMed  Google Scholar 

  60. Rausa E, Zappa MA, Kelly ME et al (2019) A standardized use of intraoperative anastomotic testing in colorectal surgery in the new millennium: is technology taking over? A systematic review and network meta-analysis. Tech Coloproctol 23:625–631. https://doi.org/10.1007/s10151-019-02034-6

    Article  CAS  PubMed  Google Scholar 

  61. Allaix ME, Lena A, Degiuli M et al (2018) Intraoperative air leak test reduces the rate of postoperative anastomotic leak: analysis of 777 laparoscopic left-sided colon resections. Surg Endosc. https://doi.org/10.1007/s00464-018-6421-8

    Article  PubMed  Google Scholar 

  62. Wu Z, van de Haar RCJ, Sparreboom CL et al (2016) Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis 31:1409–1417. https://doi.org/10.1007/s00384-016-2616-4

    Article  PubMed  PubMed Central  Google Scholar 

  63. Singh PP, Zeng ISL, Srinivasa S et al (2014) Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg 101:339–346. https://doi.org/10.1002/bjs.9354

    Article  CAS  PubMed  Google Scholar 

  64. Garcia-Granero A, Frasson M, Flor-Lorente B et al (2013) Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum 56:475–483. https://doi.org/10.1097/DCR.0b013e31826ce825

    Article  PubMed  Google Scholar 

  65. Pantel HJ, Jasak LJ, Ricciardi R et al (2019) Should they stay or should they go? the utility of c-reactive protein in predicting readmission and anastomotic leak after colorectal resection. Dis Colon Rectum 62:241–247. https://doi.org/10.1097/DCR.0000000000001225

    Article  PubMed  Google Scholar 

  66. Martin G, Dupré A, Mulliez A et al (2015) Validation of a score for the early diagnosis of anastomotic leakage following elective colorectal surgery. J Visc Surg 152:5–10. https://doi.org/10.1016/j.jviscsurg.2014.12.002

    Article  CAS  PubMed  Google Scholar 

  67. den Dulk M, Noter SL, Hendriks ER et al (2009) Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol 35:420–426. https://doi.org/10.1016/j.ejso.2008.04.009

    Article  Google Scholar 

  68. den Dulk M, Witvliet MJ, Kortram K et al (2013) The DULK (Dutch leakage) and modified DULK score compared: actively seek the leak. Colorectal Dis 15:e528–533

    Google Scholar 

  69. Italian ColoRectal Anastomotic Leakage (iCral) Study Group (2020) Anastomotic leakage after elective colorectal surgery: a prospective multicentre observational study on use of the Dutch leakage score, serum procalcitonin and serum C-reactive protein for diagnosis. BJS Open. https://doi.org/10.1002/bjs5.50269

    Article  Google Scholar 

  70. Giaccaglia V, Salvi PF, Cunsolo GV et al (2014) Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery. J Crit Care 29:528–532. https://doi.org/10.1016/j.jcrc.2014.03.036

    Article  CAS  PubMed  Google Scholar 

  71. Ortega-Deballon P, Radais F, Facy O et al (2010) C-reactive protein is an early predictor of septic complications after elective colorectal surgery. World J Surg 34:808–814. https://doi.org/10.1007/s00268-009-0367-x

    Article  PubMed  PubMed Central  Google Scholar 

  72. Oberhofer D, Juras J, Pavicić AM et al (2012) Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery. Croat Med J 53:612–619. https://doi.org/10.3325/cmj.2012.53.612

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Giaccaglia V, Salvi PF, Antonelli MS et al (2016) Procalcitonin reveals early dehiscence in colorectal surgery: the PREDICS Study. Ann Surg 263:967–972. https://doi.org/10.1097/SLA.0000000000001365

    Article  PubMed  Google Scholar 

  74. Facy O, Paquette B, Orry D et al (2016) Diagnostic accuracy of inflammatory markers as early predictors of infection after elective colorectal surgery: results from the IMACORS Study. Ann Surg 263:961–966. https://doi.org/10.1097/SLA.0000000000001303

    Article  PubMed  Google Scholar 

  75. Cousin F, Ortega-Deballon P, Bourredjem A et al (2016) Diagnostic accuracy of procalcitonin and C-reactive protein for the early diagnosis of intra-abdominal infection after elective colorectal surgery: a meta-analysis. Ann Surg 264:252–256. https://doi.org/10.1097/SLA.0000000000001545

    Article  PubMed  Google Scholar 

  76. Kaur P, Karandikar SS, Roy-Choudhury S (2014) Accuracy of multidetector CT in detecting anastomotic leaks following stapled left-sided colonic anastomosis. Clin Radiol 69:59–62. https://doi.org/10.1016/j.crad.2013.08.006

    Article  CAS  PubMed  Google Scholar 

  77. ASGBA_The_surgical_management_of_patients_with_acute_intestinal_failure.pdf (2020). https://www.irspen.ie/wp-content/uploads/2014/10/ASGBA_The_surgical_management_of_patients_with_acute_intestinal_failure.pdf. Accessed 25 May 2020.

  78. Saur NM, Paulson EC (2019) Operative management of anastomotic leaks after colorectal surgery. Clin Colon Rectal Surg 32:190–195. https://doi.org/10.1055/s-0038-1677025

    Article  PubMed  PubMed Central  Google Scholar 

  79. Blumetti J, Abcarian H (2015) Management of low colorectal anastomotic leak: Preserving the anastomosis. World J Gastrointest Surg 7:378–383. https://doi.org/10.4240/wjgs.v7.i12.378

    Article  PubMed  PubMed Central  Google Scholar 

  80. van Koperen PJ, van Berge Henegouwen MI, Rosman C et al (2009) The Dutch multicenter experience of the endo-sponge treatment for anastomotic leakage after colorectal surgery. Surg Endosc 23:1379–1383. https://doi.org/10.1007/s00464-008-0186-4

    Article  PubMed  Google Scholar 

  81. SCCM | Surviving Sepsis Campaign (SSC) (2020). https://www.sccm.org/SurvivingSepsisCampaign/Home. Accessed 25 May 2020.

  82. Daniels R, Nutbeam T, McNamara G, Galvin C (2011) The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J 28:507–512. https://doi.org/10.1136/emj.2010.095067

    Article  PubMed  Google Scholar 

  83. Adams SJ (2001) Projecting the next decade in safety management: a Delphi technique study. Prof Saf 46:26–29

    Google Scholar 

  84. Hsu C-C, Sandford BA (2007) The Delphi technique: making sense of consensus. Pract Asses Res Eval 12:9

    Google Scholar 

  85. Walker AM, Selfe J (1996) The Delphi method: a useful tool for the allied health researcher. Int J Ther Rehab 3:677–681

    Article  Google Scholar 

  86. Campbell SM, Braspenning J, Hutchinson A, Marshall M (2002) Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care 11:358–364. https://doi.org/10.1136/qhc.11.4.358

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Jones IW, Hooker RS (2011) Physician assistants in Canada: update on health policy initiatives. Can Fam Phys 57:e83–88

    Google Scholar 

  88. Minas H, Jorm AF (2010) Where there is no evidence: use of expert consensus methods to fill the evidence gap in low-income countries and cultural minorities. Int J Ment Health Syst 4:33. https://doi.org/10.1186/1752-4458-4-33

    Article  PubMed  PubMed Central  Google Scholar 

  89. Meshkat B, Cowman S, Gethin G et al (2014) Using an e-Delphi technique in achieving consensus across disciplines for developing best practice in day surgery in Ireland. J Hosp Admin. https://doi.org/10.5430/jha.v3n4p1

    Article  Google Scholar 

  90. Powell C (2003) The Delphi technique: myths and realities. J Adv Nurs 41:376–382. https://doi.org/10.1046/j.1365-2648.2003.02537.x

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy

    Antonino Spinelli & Caterina Foppa

  2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

    Antonino Spinelli & Marco Montorsi

  3. Dipartimento di Scienze Mediche-Università di Ferrara, Azienda Ospedaliero Universitaria S. Anna, Ferrara, Italy

    Gabriele Anania

  4. Department of Surgical Sciences, University of Torino, Torino, Italy

    Alberto Arezzo

  5. S.C. Chirurgia Generale, Dipartimento Chirurgico, ASL 5 Spezzino-POLL-Regione Liguria, La Spezia, Italy

    Stefano Berti

  6. General and Colo-Rectal Surgery Unit, S. Leonardo-ASL Naples 3 Hospital, C.mare di Stabia, Naples, Italy

    Francesco Bianco

  7. UOC di Chirurgia Generale e Mini-Invasiva, Dipartimento di Chirurgia Generale e Specialistiche, ASL Toscana Sud-Est. Ospedale Misericordia, Grosseto, Italy

    Paolo Pietro Bianchi

  8. Department of Oncology, Head, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy

    Maurizio De Giuli

  9. Gastrointestinal Surgery, Scientific Institute San Raffaele Hospital, Milan, Italy

    Paola De Nardi

  10. Città della Salute-Ospedale Molinette, Torino, Italy

    Paolo de Paolis

  11. Clinica Chirurgica Generale e d’urgenza, Università Politecnica delle Marche, Ancona, Italy

    Mario Guerrieri

  12. Surgery Unit, San Camillo Forlanini Hospital, Rome, Italy

    Pierluigi Marini

  13. Minimally-Invasive Surgical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy

    Roberto Persiani

  14. U.O.C. Chirurgia Oncologica, ARNAS Garibaldi, Catania, Italy

    Diego Piazza

  15. Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Gilberto Poggioli

  16. Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche–DISCOG, Università di Padova, Padova, Italy

    Salvatore Pucciarelli

  17. General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy

    Domenico D’Ugo

  18. Department of General Surgery, Fatebenefratelli Hospital, Naples, Italy

    Adolfo Renzi

  19. Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy

    Francesco Selvaggi

  20. Deparment of Medico-Surgical Science and Biotechnologies, Sapienza University of Rome, Rome, Italy

    Gianfranco Silecchia

  21. Department of Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy

    Marco Montorsi

Authors
  1. Antonino Spinelli
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  2. Gabriele Anania
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  3. Alberto Arezzo
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  4. Stefano Berti
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  5. Francesco Bianco
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  6. Paolo Pietro Bianchi
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  7. Maurizio De Giuli
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  9. Paolo de Paolis
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  10. Caterina Foppa
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  11. Mario Guerrieri
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  12. Pierluigi Marini
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  13. Roberto Persiani
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  14. Diego Piazza
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  15. Gilberto Poggioli
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  16. Salvatore Pucciarelli
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  17. Domenico D’Ugo
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  18. Adolfo Renzi
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  19. Francesco Selvaggi
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  20. Gianfranco Silecchia
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  21. Marco Montorsi
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Corresponding author

Correspondence to Antonino Spinelli.

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Spinelli, A., Anania, G., Arezzo, A. et al. Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery. Updates Surg 72, 781–792 (2020). https://doi.org/10.1007/s13304-020-00837-z

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