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<p>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 (&lt; 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.</p>

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

  • 期刊论文

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  • 发表日期：

    2026年7月16日

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  • Renato Costi,
  • Alfredo Annicchiarico,
  • Antonio Amato,
  • Cristina Folliero,
  • Claudio Guerci,
  • Alessandro Facchinetti,
  • Filippo Montali,
  • Adolfo Petrina,
  • Agnese Dezi,
  • Agostino Falcone,
  • Agostino Fernicola,
  • Alba Oliva,
  • Alberto Buonanno,
  • Alberto Porcu,
  • Alberto Serventi,
  • Alberto Stocco,
  • Alberto Vannelli,
  • Aldo Rocca,
  • Alessandra Marano,
  • Alessandro Baggi,
  • Alessandro Bergna,
  • Alessandro De Luca,
  • Alessandro Soave,
  • Alessia Fassari,
  • Alessio Giordano,
  • Alessio Morandi,
  • Alex Bruno Bellocchia,
  • Alfredo Annicchiarico,
  • Alice Francescato,
  • Amedeo Altamura,
  • Amedeo Antonelli,
  • Andrea Scardino,
  • Andrea Balla,
  • Andrea Barberis,
  • Andrea Bondurri,
  • Andrea Bottari,
  • Andrea Divizia,
  • Andrea Grego,
  • Andrea Lauretta,
  • Andrea Marco Tamburini,
  • Andrea Martina Guida,
  • Andrea Morini,
  • Andrea Muratore,
  • Andrea Picchetto,
  • Andrea Pisani Ceretti,
  • Andrea Rusconi,
  • Andrea Tufo,
  • Andrea-Pierre Luzzi,
  • Angelo Alessandro Marra,
  • Anna Canavese,
  • Anna Guariniello,
  • Annalisa Comandatore,
  • Annalisa Pascariello,
  • Antonella Nicotera,
  • Antonella Usai,
  • Antonella Veglia,
  • Antonia Lavinia Zuliani,
  • Antonino Agrusa,
  • Antonio Amato,
  • Antonio Azzinnaro,
  • Antonio Bocchino,
  • Antonio Cardarelli,
  • Antonio Castaldi,
  • Antonio Langone,
  • Antonio Luberto,
  • Arcangelo Picciariello,
  • Armando Di Dato,
  • Beatrice Pisillo,
  • Beatrice Torre,
  • Belinda De Simone,
  • Biagio Picardi,
  • Brunella M. Pirozzi,
  • Bruno Nardo,
  • Bruno Scotto,
  • Bruno Sensi,
  • Carla Tasca,
  • Carlo Alberto Manzo,
  • Carlo Giove,
  • Carlo Salvemini,
  • Carmen Sorrentino,
  • Carolina Bartolini,
  • Casoni Pattacini Gianmaria,
  • Caterina Baldi,
  • Caterina Foppa,
  • Chiara Bettini,
  • Chiara Casadei,
  • Chiara Gatto,
  • Chiara Marafante,
  • Chiara Piceni,
  • Christian Franzini,
  • Claudio Cimmino,
  • Claudio Guerci,
  • Claudio Luciani,
  • Colognesi Alberto,
  • Cosimo Damiano Francione,
  • Cristina Larotonda,
  • Dajana Glavas,
  • Daniela Daidone,
  • Daniela Rega,
  • Daniele Delogu,
  • Daniele Fusario,
  • Daniele Morezzi,
  • Danilo Vinci,
  • Dario Borreca,
  • Dario Parini,
  • Dario Somenzi,
  • Daunia Verdi,
  • David Alessio Merlini,
  • Davide Cuneo,
  • Davide Ferrari,
  • Davide Mascali,
  • Davide Montani,
  • Davina Perini,
  • De Flaviis Mattia,
  • Dhimiter Cuka,
  • Diego Coletta,
  • Diletta Corallino,
  • Edoardo Baldini,
  • Edoardo Forcignanó,
  • Edoardo Virgilio,
  • Elena Martinuzzi,
  • Elena Orsenigo,
  • Eleonora Pozzi,
  • Elisa Bolzoni,
  • Elisa Galasso,
  • Emanuele Damiano Luca Urso,
  • Emanuele Pontecorvi,
  • Emilio Paolo Emma,
  • Enrico Pinotti,
  • Erica Monati,
  • Erika Boriani,
  • Ernesto Tartaglia,
  • Ester Marra,
  • Ezio Lombardo,
  • Fabio Ambrosini,
  • Fabio Carbone,
  • Fabio Marino,
  • Fabrizio D’Acapito,
  • Fabrizio Perrone,
  • Fabrizio Romano,
  • Federica Billeci,
  • Federica Cavalera,
  • Federica De Robertis,
  • Federico Cozzani,
  • Federico Festa,
  • Federico Lovisetto,
  • Federico Maggi,
  • Federico Mariani,
  • Federico Mazzotti,
  • Felice Mucilli,
  • Filippo Carannante,
  • Filippo Montali,
  • Francesca Abbatini,
  • Francesca Albanesi,
  • Francesca Ascari,
  • Francesca Paola Tropeano,
  • Francesca Pecchini,
  • Francesco Belia,
  • Francesco Bianco,
  • Francesco Colli,
  • Francesco Giovanni Cinieri,
  • Francesco Matarazzo,
  • Francesco Menegon Tasselli,
  • Francesco Milardi,
  • Francesco Pata,
  • Francesco Persico,
  • Francesco Salvetti,
  • Francesco Tartamella,
  • Gabriela Aracelly Arroyo Murillo,
  • Gabriele Anania,
  • Gabriele Ricci,
  • Gabriella Lionetto,
  • Gabriella Teresa Capolupo,
  • Gaetano Luglio,
  • Gennaro Giovine,
  • Gennaro Mazzarella,
  • Gerti Dajti,
  • Giacomo Ambrogi,
  • Giacomo Arcuri,
  • Giacomo Carganico,
  • Giacomo Franzini,
  • Giacomo Fuschillo,
  • Giacomo Mascheri,
  • Giada Pattaro,
  • Gian Andrea Binda,
  • Gian Luca Baiocchi,
  • Gianluca Baronio,
  • Gianluca Cassese,
  • Gianluca Fucci,
  • Gianluca Garulli,
  • Gianluca Mascianà,
  • Gianluca Rizzo,
  • Gianluca Vanni,
  • Gianluigi Moretto,
  • Gianmario Edoardo Poto,
  • Gianpiero Gravante,
  • Giorgia Gualtieri,
  • Giorgio Lisi,
  • Giorgio Rossi,
  • Giovanna Pavone,
  • Giovanni Alemanno,
  • Giovanni Aprea,
  • Giovanni Bellanova,
  • Giovanni Castagna,
  • Giovanni Cestaro,
  • Giovanni Guglielmo Laracca,
  • Giovanni Scudo,
  • Giovanni Spiezio,
  • Giovanni Tomasicchio,
  • Giulia Citrigno,
  • Giulia Germiniasi,
  • Giulia Lauteri,
  • Giulia Marini,
  • Giulia Paradiso,
  • Giulia Turri,
  • Giuliano Barugola,
  • Giuliano Lantone,
  • Giulio Iacob,
  • Giuseppe Curro,
  • Giuseppe Frazzetta,
  • Giuseppe Giuliani,
  • Giuseppe Massimiliano De Luca,
  • Giuseppe Navarra,
  • Giuseppe Nigri,
  • Giuseppe Palomba,
  • Giuseppe Sica,
  • Gloria Goi,
  • Guenda Pulcina,
  • Guglielmo Clarizia,
  • Guglielmo Giannotti,
  • Guido Sciaudone,
  • Helen Yu,
  • Iacopo Monaci,
  • Ilaria Benzoni,
  • Ilaria Clementi,
  • Ilaria Ferrante,
  • Imerio Angriman,
  • Irene Fiume,
  • Irene Tucceri Cimini,
  • Jacopo Mercuri,
  • Jacopo Weindelmayer,
  • Juhye Jeong,
  • Laura Fortuna,
  • Laura Olivieri,
  • Lavinia Piombetti,
  • Leandro Siragusa,
  • Leonardo Rossi,
  • Leonardo Solaini,
  • Letizia Malucchi,
  • Letizia Santandrea,
  • Linda Gabellini,
  • Livio Iudici,
  • Lorenza Beomonte Zobel,
  • Lorenzo Arlia,
  • Lorenzo Epis,
  • Lorenzo Pagliai,
  • Lorenzo Petagna,
  • Lorenzo Vona,
  • Luca Cardinali,
  • Luca Cestino,
  • Luca Domenico Bonomo,
  • Luca Fabris,
  • Luca Ferrario,
  • Luca Mattia Quarti,
  • Luca Morelli,
  • Luca Perin,
  • Luca Resca,
  • Luca Salvador,
  • Luca Scaravilli,
  • Luca Sullo,
  • Luca Tirloni,
  • Luca Vicenzi,
  • Ludovico Carbone,
  • Luigi Cayre,
  • Luigi Eduardo Conte,
  • Luigi Fiorello,
  • Luigi Marano,
  • Luigi Percalli,
  • Manuel Baldinu,
  • Manuela Mastronardi,
  • Marcello Pisano,
  • Marco Anania,
  • Marco Beggiato,
  • Marco Clementi,
  • Marco D’Ambrosio,
  • Marco Giacometti,
  • Marco Materazzo,
  • Marco Pellicciaro,
  • Marco Realis Luc,
  • Marco Sparavigna,
  • Margherita Carbonaro,
  • Maria Carmela Giuffrida,
  • Maria Francesca Chiappetta,
  • Maria Roberta Fortunato,
  • Maria Rosa D’Anna,
  • Mariafelicia Valeriani,
  • Marianna Capuano,
  • Marianna Petrillo,
  • Marina Valente,
  • Mario Annecchiarico,
  • Mario Giuffrida,
  • Mario Pacilli,
  • Mario Sorrentino,
  • Marta Goglia,
  • Marta Mozzon,
  • Martina Bonafede,
  • Marzia Franceschilli,
  • Massimiliano Mistrangelo,
  • Massimo Fedi,
  • Matelda Bencini,
  • Matteo Palmeri,
  • Matteo Rossini,
  • Maurizio Rho,
  • Maurizio Romano,
  • Maurizio Roveroni,
  • Maurizio Zizzo,
  • Mauro Filosa,
  • Mauro Marzano,
  • Mauro Montuori,
  • Mauro Podda,
  • Mauro Pozzo,
  • Mauro Santarelli,
  • Michela Campanelli,
  • Michele Bellofiore,
  • Michele Manara,
  • Michele Manigrasso,
  • Mirko Barone,
  • Nicholas Rizzi,
  • Nick Salimian,
  • Nicola Cillara,
  • Nicola Leone,
  • Nicola Tartaglia,
  • Nicole Josephine Castiglia,
  • Nicolò De Santis,
  • Nicolò Falco,
  • Nicolò Pizzetti,
  • Nicolò Turco,
  • Nirvana Maroni,
  • Oliva Giusepina,
  • Omar Ghazouani,
  • Oreste Claudio Buonomo,
  • Pamela Milito,
  • Paola Batistotti,
  • Paola De Nardi,
  • Paolina Saullo,
  • Paolo Carcoforo,
  • Paolo Massucco,
  • Paolo Ossola,
  • Paolo Pizzini,
  • Paolo Vincenzi,
  • Pasquale Losurdo,
  • Pierluigi Angelini,
  • Pierpaolo Sileri,
  • Pietro Anoldo,
  • Pietro Fransvea,
  • Pietro Giorgio Calò,
  • Raffaele De Filippi,
  • Raffaele Galleano,
  • Raffaele Lombardi,
  • Renato Pietroletti,
  • Riccardo Borreca,
  • Riccardo Fratarcangeli,
  • Riccardo Marsengo,
  • Roberta Longhin,
  • Roberta Tutino,
  • Roberto Cammarata,
  • Roberto Perinotti,
  • Rocco Aversa,
  • Rocco Pasqua,
  • Rosita De Vincenti,
  • Sabino Capuzzolo,
  • Salvatore Buscemi,
  • Salvatore De Maria,
  • Samuele Vaccari,
  • Sandro Giannessi,
  • Sante Capitano,
  • Sara Cecconi,
  • Sara Crociato,
  • Sara Gobbi,
  • Sara Ingallinella,
  • Sara Lauricella,
  • Sara Vertaldi,
  • Sebastian Tiso,
  • Serena Molica,
  • Sergio Sforza,
  • Silvia Curcio,
  • Silvia Negro,
  • Silvia Neri,
  • Simona Ascanelli,
  • Simona Badalucco,
  • Simona Pisicchio,
  • Simone Buccianti,
  • Simone Gargarella,
  • Simone Guadagni,
  • Simone Muratori,
  • Sofia Esposito,
  • Sophia Costacurta,
  • Stefania Bettoni,
  • Stefania Piccioni,
  • Stefano Barbieri,
  • Stefano Carini,
  • Stefano Lafranceschina,
  • Stefano Olmi,
  • Stefano Rossi,
  • Stefano Scabini,
  • Teresa Perra,
  • Tommaso Farolfi,
  • Tommaso Fontana,
  • Tommaso Iaquinta,
  • Tommaso Loderer,
  • Tommaso Violante,
  • Ugo Grossi,
  • Valentina Rampulla,
  • Valentina Zucchini,
  • Vania Silvestri,
  • Vincenza Paola Dinuzzi,
  • Vincenzo Adamo,
  • Vincenzo Schiavone,
  • Vincenzo Trapani,
  • Vittoria Bellato,
  • Vittoria Grammatico,
  • Gian Andrea Binda

摘要

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.