27 April 2016

Anastomotic dehiscence is perhaps the complication that is feared most by colorectal surgeons. It is associated with substantial morbidity and mortality and is generally considered to represent a failure of technique, whether it is or not. As a result, anastomotic dehiscence rates have come to be regarded as a measure of a surgeon’s skill despite the fact that factors outside of the surgeon’s control can often be responsible.

Guidance research method

Although a lot has been written on this subject the quality of the evidence base is not uniform, and when ACPGBI and ASGBI agreed to collaborate on writing guidance on the prevention, diagnosis and the management of colorectal anastomotic leakage it became clear that a systematic review of the literature would not be sufficient. For this reason it was decided to employ a Delphi process to inform the guidance. The first meeting of the Delphi Group took place at the Tripartite Meeting in Birmingham in July 2014 and the main meeting was held on 14 October at the Royal College of Surgeons in London. The group consisted of ACPGBI members and they were largely experienced consultants but with some trainee representatives and a patient representative. All regions of the UK and Ireland were represented. Round one of the Delphi was completed prior to the October meeting by means of an online questionnaire and the second two rounds were completed at the meeting itself. Thus the resultant guidance was a combination of evidence from the literature and expert opinion derived from the Delphi process.

Outline of the guidance on anastomotic dehiscence

The document is divided into the following main sections:

1. Definitions and epidemiology
2. Avoidance
3. Diagnosis
4. Treatment
5. Management of specific patterns of anastomotic leakage

In this last section, using a combination of consensus and evidence, levels of severity of anastomotic dehiscence are defined and linked to appropriate management strategies. It is hoped that this document will provide colorectal surgeons with a degree of security around their decision making with regard to anastomotic dehiscence, and I should like to pay tribute to Des Winter for initiating and steering the process, Gordon Carlson for his sterling work on the many drafts of the guidance and to Frank McDermott and Sonal Arora for their hard work on the literature review and conducting the Delphi process. Professor RJC Steele, ACPGBI President Anastomotic dehiscence guidance

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