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Updated: Jan 23, 2026

Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
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The utility of the delphi method in defining anastomotic leak following colorectal surgery
Vijaya T Daniel1, Karim Alavi1, Jennifer S Davids1
1Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Background:
Almost a decade after international guidelines defining anastomotic leak (AL) were published, the definition of AL remains inconsistent.
Methods:
A 3-round modified Delphi study was conducted among a national panel of 8 surgeon experts to assess consensus related to the definition of AL following colorectal resection. Consensus was defined when a scenario was rated as very important or absolutely essential by at least 85% of the experts in round 3.
Results:
Seven of fifteen (47%) clinical and radiological scenarios of AL achieved consensus. 80% of clinical scenarios reached consensus. 30% of radiological scenarios reached consensus including CT demonstrating air bubbles around the anastomosis. No consensus was achieved in 70% of radiological scenarios.
Conclusions:
Consensus on the definition of AL is difficult to reach, in relation to international guidelines; which implies that further refinement of the definition of AL is needed to compare patient outcomes.
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