Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal su
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ORIGINAL ARTICLE
Italian multi‑society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery Antonino Spinelli1,2 · Gabriele Anania3 · Alberto Arezzo4 · Stefano Berti5 · Francesco Bianco6 · Paolo Pietro Bianchi7 · Maurizio De Giuli8 · Paola De Nardi9 · Paolo de Paolis10 · Caterina Foppa1 · Mario Guerrieri11 · Pierluigi Marini12 · Roberto Persiani13 · Diego Piazza14 · Gilberto Poggioli15 · Salvatore Pucciarelli16 · Domenico D’Ugo17 · Adolfo Renzi18 · Francesco Selvaggi19 · Gianfranco Silecchia20 · Marco Montorsi21,2 Received: 9 April 2020 / Accepted: 21 June 2020 © Italian Society of Surgery (SIC) 2020
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. Keywords Anastomotic leakage · Colorectal surgery · Consensus · Delphi · Definition · Management
Introduction Anastomotic leak (AL) remains one of the most feared, potentially life-threatening complications in colorectal surgery due to its devastating impact on patients’ post-operative course, quality of life, and survival [1–3]. Notwithstanding the advances in surgical techniques and perioperative care, the incidence of AL has not substantially decreased over the past decades [4, 5] and some important grey areas remain: Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13304-020-00
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