Consensus on the definition of colorectal anastomotic leakage: A modified Delphi study

Abstract

BACKGROUND Despite the emerging knowledge about colorectal anastomotic leakage (CAL) through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is complicated. AIM To reach consensus on the definition of CAL using a modified Delphi method. METHODS The RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or disagreed. RESULTS Twenty-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items (80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16 (84%) agreed with our final recommendations for the definition of CAL. CONCLUSION A consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.

Management of colorectal anastomotic leakage using endoscopic negative pressure therapy with or without protective ostomy: a retrospective study

“…In our study, the median time to AL detection was similar in both subgroups, nOB and OB, although the range within the OB subgroup reached 120 days. This “late” leak may be explained due to the clinical condition of the patients (i.e., high ASA score, neoadjuvant radiotherapy, high Charlson Comorbidity Index) as recently suggested by van Helsdingen et al [ 2 ]. Contrarily, “early” leaks are suggested to be more related to surgery.…”

“…Patients were divided into groups according to the AL classification of the International Study Group of Rectal Cancer (ISREC), which was recently considered as the most frequently used classification [ 2 , 9 ]: grade A—asymptomatic AL; grade B—AL requiring active therapy but no revision surgery; grade C—AL requiring re-laparotomy or laparoscopy. All groups were further analyzed with regard to AL management, ENPT system changes, leakage characteristics, time to cavity closure (defined as duration in days, from ENPT begin until completion), and complications.…”

“…Anastomotic leakage (AL) represents a major complication in patients undergoing colorectal surgery since it correlates with high rates of short- and long-term morbidity, as well as with increased health care costs. AL therapy depends on the intra- or extraperitoneal localization of the leak and various clinical parameters such as localized or generalized peritonitis and sepsis [ 1 , 2 ]. In addition, specific conditions such as the presence of a protective ostomy, blood perfusion at the anastomotic site, or leak characteristics influence AL management.…”

Major stoma related morbidity in young children following stoma formation and closure: A retrospective cohort study

“…For anastomotic leakage, the definition and classification of the International Study Group of Rectal Cancer (ISREC) was used. [13,14] There is no consensus on a definition for anastomotic stenosis. For this reason, anastomotic stenosis was presumed in patients with obstructive symptoms and description of a stenosis at the anastomotic site seen on contrast enema or during surgery.…”

The windsor definition for hyperemesis gravidarum: A multistakeholder international consensus definition

“…[36,44] Compared to panel sizes described in other studies on disease definition using the Delphi technique published in the last five years, our study's panel size of 96 participants in the final round was among the largest of its kind, although this fully cannot rule out possible lack of robustness of findings if an even larger panel size had been employed. [29,[45][46][47][48] Furthermore, there were no differences between those participants that completed all rounds, and those who dropped out, leading us to believe that attrition bias was not a major issue (appendix M). Second, the majority of participants had a high level of education (88%), 92% had a white background, and low-and middle-income countries were poorly represented, each of which may have reduced the external validity although it is difficult to hypothesise how this could have affected our conclusions.…”