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Standardized Algorithms for Management of Anastomotic Leaks and Related Abdominal and Pelvic Abscesses After Colorectal Surgery

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Abstract

Background

The risk factors and incidence of anastomotic leak following colorectal surgery are well reported in the literature. However, the management of the multiple clinical scenarios that may be encountered has not been standardized.

Methods

The medical literature from 1973 to 2007 was reviewed using PubMed for papers relating to anastomotic leaks and abdominal abscess, with a specific emphasis on predisposing factors, prevention strategies, and treatment approaches. A six-round modified Delphi research method was utilized to find consensus among a group of expert colorectal surgeons and interventional radiologists regarding standardized management algorithms for anastomotic leaks.

Results

Management scenarios were divided into those for intraperitoneal anastomoses, extraperitoneal (low pelvic) anastomoses, and anastomoses with proximal diverting stomas. Management options were then based on the clinical presentation and radiographic findings and organized into three interconnected algorithms.

Conclusions

This process was a useful first step toward establishing guidelines for the management of anastomotic leak.

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Acknowledgments

The International Anastomotic Leak Study Group consisted of an initial hypothesis group of R. Phitayakorn, C.P. Delaney, H.L. Reynolds, B.J. Champagne, A.G. Heriot, P. Neary, A.J. Senagore and an international collaborative group of the following coauthors: P. Ambrosetti, University Hospital, Geneva, Switzerland; C. Bailey, Universite Louis Pasteur, Strasbourg, France; R.P. Billingham, University of Washington, Seattle, Washington, USA; M. Braga, San Raffaele University Vita-Salute, Milan, Italy; W.D. Buie, University of Calgary, Calgary, Alberta, Canada; A.W. Darzi, Imperial College, London, UK; P.R. Douglas, Prince of Wales Hospital, University of New South Wales, Sydney, Australia; E.J. Dozois, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA; N.S. Fearnhead, Addenbrooke’s Hospital, Cambridge, UK; F.A. Frizelle, Christchurch Hospital, Christchurch, New Zealand; S.L. Gearhart, Johns Hopkins Medical Institutions, Lutherville, MD, USA; Q.H. Gonzalez, Instituto Nacional de Ciencias Medicas y Nutricion S.Z., Tlalpan, Mexico City, Mexico; J.R. Haaga, University Hospitals of Cleveland, Cleveland, OH, USA; G.J. Harris, St. Richard’s Hospital, West Sussex, UK; A.F. Horgan, Freeman Hospital, Newcastle Upon Tyne, UK; P.G. Horgan, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, Scotland, UK; H. Kehlet, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark; S.H. Kim, Korea University Hospital, Seoul, Korea; A.M. Lacy, University of Barcelona, Barcelona, Spain; J. Leroy, Universite Louis Pasteur, Strasbourg, France; F. López-Kostner, Hospital Clínico Pontificia Universidad Católica de Chile, Chile; K.A. Ludwig, Duke University Medical Center, Durham, NC, USA; J. Marks, The Lankenau Hospital and Institute for Medical Research, Wynnewood, PA, USA; A.J. Megibow, New York University School of Medicine, New York, NY, USA; J.I. Merlino, MetroHealth Medical Center, Cleveland, OH, USA; J.R. Monson, University of Hull and Castle Hill Hospital, Hull, East Yorkshire, UK; R.W. Motson, Colchester General Hospital, Turner Road, Colchester, UK; D.A. Nakamoto, University Hospitals of Cleveland, Cleveland, OH, USA; G.L. Newstead, Sydney Colorectal Associates, Prince of Wales Private Hospital, New South Wales, Australia; P.R. O’Connell, Mater Misericordiae University Hospital, Dublin, Ireland; Y. Panis, Beaujon Hospital, Clichy-Paris, France; F. Penninckx, University Clinic Gasthuisberg, Leuven, Belgium; A. Rajput, Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY, USA; F. Seow Choen, Mt. Elizabeth Medical Centre, Singapore; M.J. Stamos, University of California, Irvine School of Medicine, Orange, CA, USA; A. Vignali, San Raffaele University Vita-Salute, Milan, Italy; S.D. Wexner, Cleveland Clinic Florida, Weston, FL, USA; K.S. Wong, National University Hospital Singapore, Yong Loo Lin School of Medicine, Singapore

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Authors and Affiliations

  1. Division of Colorectal Surgery, Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio, 44106-5047, USA

    R. Phitayakorn, C. P. Delaney, H. L. Reynolds & B. J. Champagne

  2. Peter MacCallum Cancer Centre, Melbourne, Australia

    A. G. Heriot

  3. Adelaide and Meath Hospital, Incorporating the National Childrens Hospital, Dublin, Ireland

    P. Neary

  4. Michigan State University, Grand Rapids, Michigan, USA

    A. J. Senagore

Authors
  1. R. Phitayakorn
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  2. C. P. Delaney
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  3. H. L. Reynolds
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  4. B. J. Champagne
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  5. A. G. Heriot
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  6. P. Neary
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  7. A. J. Senagore
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International Anastomotic Leak Study Group

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Correspondence to C. P. Delaney.

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Phitayakorn, R., Delaney, C.P., Reynolds, H.L. et al. Standardized Algorithms for Management of Anastomotic Leaks and Related Abdominal and Pelvic Abscesses After Colorectal Surgery. World J Surg 32, 1147–1156 (2008). https://doi.org/10.1007/s00268-008-9468-1

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