OBJECTIVES: Anastomotic leaks occur in up to 36% of colorectal resections, and result in a significant clinical and economic burden. Intraoperative approaches to managing positive leak tests vary greatly. This study aimed to understand the range and prevalence of interventions following positive intraoperative leak tests during colorectal resections performed with a circular stapler. METHODS:

In this retrospective cross-sectional study, electronic medical records (EMR) of patients with a positive leak test during a colon resection were reviewed. Surgeon information, patient demographics, comorbidities, surgical techniques, intraoperative interventions and post-operative outcomes were extracted from a minimum of 50 EMR per country (France, Germany, Italy, United Kingdom). The results from Germany are reported here. Statistics are reported as average ± standard deviation. RESULTS: Data from 239 patients with primary or metastatic colorectal cancer were reviewed. 80 patients underwent laparoscopic left hemicolectomy, 56 laparoscopic sigmoidectomy, 23 open left hemicolectomy, 16 open sigmoidectomy and 64 anterior rectal resection. Intraoperative leak testing was performed using the air leak test in 165 patients, methylene blue dye test in 69 patients and saline insufflation test in 5 patients. Following a positive test, 158 patients underwent oversewing of the staple line (mean 3 suture strands used), sealant was applied in 55 patients (mean 2 sealant tubes used) and a new anastomosis was created in 30 patients (all with circular stapler). The average time required for the interventions was 24.20 ± 25.48 minutes. A post-operative leak occurred in 0 patients. CONCLUSIONS: Most intraoperative leaks are managed by oversewing the anastomotic staple line or by applying a surgical sealant, which can be time-, labor- and cost-intensive. Approaches towards standardizing anastomotic creation may help reduce the incidence of intraoperative leaks and the variability in interventions.