ArticleWorld journal of surgery2025
Management of Low Colorectal/Coloanal Anastomotic Leak: Results of a French National Intergroups Practice Survey (FRENCH-GRECCAR-SFCD).
Article in World journal of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
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- Invited Commentary: Management of Low Colorectal/Coloanal Anastomotic Leak: Results of a French National Inter-Groups Practice Survey.World journal of surgery · 2025Article
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Authors and funding
12 authors.
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Abstract
aimsAnastomotic leakage (AL) impacts short-term and long-term outcomes after colorectal surgery, yet no consensus exists regarding its diagnosis and management. The aim was to establish a proactive consensus-based approach for diagnosing and treating AL following rectal cancer surgery through a national survey.
methodsA questionnaire was designed to assess 24 clinical scenarios related to the diagnosis and management of fistulas in low colorectal (LCA) or coloanal anastomosis (CAA) with a diverting ileostomy.
resultsA total of 203 surgeons from three surgical societies participated. Consensus was reached on four key indicators warranting further investigation of AL: CRP > 250 mg/L, fever ≥ 38.5°C, tachycardia > 100 bpm, and diffuse abdominal pain. In the presence of any warning sign, 87% recommended an urgent contrast-enhanced abdominopelvic CT scan without routine rectal contrast as the first-line diagnostic tool. Isolated extra-digestive air bubbles or uncollected effusions without air bubbles were managed with antibiotics (61%-78%). A perianastomotic collection required an anal examination under general anesthesia (70%). For treatment, transanal drainage (56%) was preferred over image-guided percutaneous drainage, combined with endoluminal vacuum therapy and at least 7 days of antibiotics (97%). Drain removal was recommended (64%) when imaging confirmed the absence of residual collection.
conclusionsThis national survey established a consensus-driven proactive management algorithm for LCA/CAA fistulas. Further validation controlled trial is needed to confirm the effectiveness in reducing AL-related complications.
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