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.