Prevention and management of anastomotic leakage after colorectal resection: evolving trends among Italian surgeons. A SICCR survey

Anastomotic leakage (AL) remains one of the most feared complications after colorectal resection. Although several strategies have been introduced in the fields of AL prevention, diagnosis and management, their application in clinical practice is still to be assessed. A 26-item-questionnaire was administered between December 2023 and March 2024 to residents in general surgery and surgeons to analyse the actual clinical practice in Italy, in general and with respect of surgical experience in colorectal surgery. A total of 414 responses were analyzed. Most respondents were general surgeons/residents working in public or university hospitals; over one-half had limited surgical experience (< 50 colectomies). Regarding low colo-rectal anastomosis techniques, Knight-Griffen technique (44.0%) and hand-sewn colo-anal anastomosis (37.4%) were the most commonly reported. "Preventive" measures included reinforcement sutures (29.7%) and dog-ear avoidance procedures (21.7%); among intraoperative tests, hydropneumatic leak test (94.9%), "rings'" check (87.9%) and indocyanine green fluorescence (61.8%) were widely used. Protective stomas were created selectively in 52.4% of cases, with ileostomy largely preferred (93.9%). Despite ERAS recommendations, drains were frequently placed, particularly after anterior resection (73.7%). In the case of paucisymptomatic leak, conservative management was preferred (73.4% for ileo-colic, 65.9% for colorectal), at times associated with endoscopic procedures (15.2%). Decisions regarding diverting stomas or Hartmann's proedures were mainly driven by clinical presentation rather than AL size. Endoscopic treatments, especially intracavitary "sponge" placement, have gained widespread acceptance. This survey highlights partial adoption of current guidelines. Although traditional practices, including drainage placement, persist, conservative and endoscopic approaches are increasingly adopted in the management of AL.

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Publication Details

Journal
Updates in Surgery
Published
2026-07-16
DOI
https://doi.org/10.1007/s13304-026-02625-7
Primary Topic
Colorectal Cancer Surgical Treatments
Type
article
Field-Weighted Citation Impact
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article

Prevention and management of anastomotic leakage after colorectal resection: evolving trends among Italian surgeons. A SICCR survey

Alessio Morandi, Daniela Rega, Cristina Folliero, Bruno Sensi et al.
Updates in Surgery
Colorectal Cancer Surgical Treatments
article

Prevention and management of anastomotic leakage after colorectal resection: evolving trends among Italian surgeons. A SICCR survey

Alessio Morandi, Daniela Rega, Cristina Folliero, Bruno Sensi, Alberto Buonanno, Dajana Glavas, Carmen Sorrentino, A. Cardarelli, Bruno Scotto, Amedeo Altamura, Alessia Fassari, Antonio Azzinnaro, Andrea Martina Guida, Armando Di Dato, Antonio Luberto, Antonella Nicotera, Christian Franzini, Annalisa Pascariello, Alberto Serventi, Alessandro Soave, Andrea Divizia, Andrea Muratore, Chiara Marafante, Agnese Dezi, Alberto Porcu, Alberto Vannelli, Andrea‐Pierre Luzzi, Alessandro Bergna, Antonio Castaldi, Antonella Veglia, Carlo Alberto Manzo, Alice Francescato, Cristina Larotonda, Claudio Guerci, Alba Oliva, Andrea Picchetto, Andrea Barberis, Antonino Agrusa, Andrea Scardino, Filippo Montali, Alberto Stocco, Chiara Bettini, Alfredo Annicchiarico, Claudio Luciani, Antonio Bocchino, Andrea Tufo, Amedeo Antonelli, A. Tamburini, Carlo Salvemini, Carlo Giove, Antonella Usai, Andrea Rusconi, Andrea Pisani Ceretti, A. Amato, Andrea Lauretta, Agostino Fernicola, Arcangelo Picciariello, Adolfo Petrina, Andrea Grego, Anna Guariniello, Alex Bruno Bellocchia, Carolina Bartolini, Antonia Lavinia Zuliani, Aldo Rocca, Beatrice Torre, Chiara Piceni, Beatrice Pisillo, Biagio Picardi, Andrea Morini, Casoni Pattacini Gianmaria, Antonio Amato, Renato Costi, Chiara Casadei, A Canavese, Alessandro Baggi, Claudio Cimmino, Daniela Daidone, Cosimo Damiano Francione, Alessandro Facchinetti, Agostino Falcone, Alessio GIORDANO, Brunella M. Pirozzi, Belinda De Simone, Caterina Baldi, Carla Tasca, Caterina Foppa, Antonio Langone, Andrea Bondurri, Chiara Gatto, Alessandro De Luca, Andrea Bottari, Annalisa Comandatore, Andrea Balla, Bruno Nardo, TabooSurvey Group, Angelo Alessandro Marra, Alessandra Marano, Colognesi Alberto
article en

Abstract

Anastomotic leakage (AL) remains one of the most feared complications after colorectal resection. Although several strategies have been introduced in the fields of AL prevention, diagnosis and management, their application in clinical practice is still to be assessed. A 26-item-questionnaire was administered between December 2023 and March 2024 to residents in general surgery and surgeons to analyse the actual clinical practice in Italy, in general and with respect of surgical experience in colorectal surgery. A total of 414 responses were analyzed. Most respondents were general surgeons/residents working in public or university hospitals; over one-half had limited surgical experience (< 50 colectomies). Regarding low colo-rectal anastomosis techniques, Knight-Griffen technique (44.0%) and hand-sewn colo-anal anastomosis (37.4%) were the most commonly reported. "Preventive" measures included reinforcement sutures (29.7%) and dog-ear avoidance procedures (21.7%); among intraoperative tests, hydropneumatic leak test (94.9%), "rings'" check (87.9%) and indocyanine green fluorescence (61.8%) were widely used. Protective stomas were created selectively in 52.4% of cases, with ileostomy largely preferred (93.9%). Despite ERAS recommendations, drains were frequently placed, particularly after anterior resection (73.7%). In the case of paucisymptomatic leak, conservative management was preferred (73.4% for ileo-colic, 65.9% for colorectal), at times associated with endoscopic procedures (15.2%). Decisions regarding diverting stomas or Hartmann's proedures were mainly driven by clinical presentation rather than AL size. Endoscopic treatments, especially intracavitary "sponge" placement, have gained widespread acceptance. This survey highlights partial adoption of current guidelines. Although traditional practices, including drainage placement, persist, conservative and endoscopic approaches are increasingly adopted in the management of AL.

Updates in Surgery
University of Parma (IT), University of Udine (IT), Luigi Sacco Hospital (IT), Presidio Ospedaliero (IT), Hesperia Hospital (IT)
Università degli Studi di Parma
Good health and well-being
Openalex Percentile: Top 12%
Colorectal Cancer Surgical Treatments
DOIOpen Access PDFOpenAlex
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