OBJECTIVES: Anastomotic leaks following colorectal resections result in a significant clinical and economic burden. To complement published data on post-operative leaks, this study aimed to understand intra-operative approaches to managing positive anastomotic leak tests.  METHODS: Electronic medical records of patients in China, Japan, and Korea with a positive leak test during colon resection were reviewed as part of a global retrospective, cross-sectional study. Surgeon information, patient demographics, comorbidities, surgical techniques, intraoperative interventions and post-operative outcomes were extracted. Statistics are reported as percentages and mean ± standard deviation.

RESULTS: Data were reviewed for 165 patients with primary or metastatic colorectal cancer who  presented a positive intra-operative leak test following resection procedure (36% anterior rectal resection, 26% laparoscopic sigmoidectomy, 14% laparoscopic left hemicolectomy, 14% open sigmoidectomy, and 10% open left hemicolectomy). Intraoperative anastomotic leak rates were estimated by participating surgeons to be at an average of 5%. Prior to leak testing, 42% patients’ anastomoses were over sewn, and over 2% were reinforced with a sealant. Following a positive test, about 90% of patients underwent over sewing of the staple line (median 4 suture strands used), sealant was applied in about 12% patients (median 2 sealant tubes used), a new anastomosis was created in about 6% patients (all with circular stapler), and about 7% had a colostomy. The average time required for these interventions was 19.4 ± 13.6 minutes. Despite addressing the intra-operative leak, a post-operative leak occurred in about 15% of patients. CONCLUSIONS: Intraoperative anastomotic leaks are mostly managed by over sewing the staple line or by applying a surgical sealant, which can be time-, labor- and cost-intensive. Significant rates of post-operative leaks were observed despite addressing intra-operative leaks. Approaches towards standardizing anastomosis creation may help reduce the incidence of intraoperative leaks, the variability in management strategies, and the subsequent outcomes.