Table 2.
Questions and Answers From Electronic Audience Response System
| Question | Answer Choice | Distribution of Responses (n=35 total respondents) |
|---|---|---|
| The Role of Technique | ||
| When an intestinal anastomosis is performed by a highly qualified, high-volume surgeon, the most common cause of a leak is? | A. Technical | 9 |
| B. Patient factors | 6 | |
| C. Unknown | 20 | |
| Considering all the elements of technique that might contribute to an anastomotic leak, which of the following is most important? | A. Blood supply | 25 |
| B. Method of construction | 4 | |
| C. Tension | 6 | |
| When an intestinal anastomosis is performed by a highly qualified, high-volume surgeon, an anastomotic leak is most often: | A. Predictable | 4 |
| B. Not predictable | 31 | |
| When an intestinal anastomosis is performed by a highly qualified, high-volume surgeon in a healthy patient under ideal conditions, and intra-operatively appears technically acceptable it: | A. Will never leak | 2 |
| B. Still can leak | 33 | |
| You are a surgeon with a 7% leak rate for colorectal anastomoses and have taken videos of 100 of your operations. You then submit the videos for evaluation by a panel of 10 expert surgeons. By watching the videos, the panel will be able to determine which patient will have an anastomotic leak: | A. Yes | 7 |
| B. No | 28 | |
| When an anastomotic leak occurs, a detailed analysis of the precise cause of leakage is able to be determined: | A. Most of the time (>50%) | 1 |
| B. Sometimes (<50%) | 20 | |
| C. Never | 14 | |
| Definition and Incidence | ||
| The surgical literature reports that the incidence of anastomotic leak is ∼10% for esophago-gastric and ∼5–10% for colo-rectal anastomosis. The true incidence of anastomotic leak is: | A. Higher than reported | 26 |
| B. Lower than reported | 0 | |
| C. Similar to reported | 9 | |
| Over the last decade, the incidence of anastomotic leaks in high-risk areas is: | A. Unchanged | 18 |
| B. Decreased significantly | 9 | |
| C. Increased significantly | 1 | |
| D. Unknown | 7 | |
| The morbidity after anastomotic leak is: | A. Insignificant: Most patients can be managed without surgery | 1 |
| B. Significant: Leak results in delay in chemotherapy, incontinence, re-operation, permanent stoma | 34 | |
| A patient has an infected fluid collection adjacent to a new anastomosis. The barium enema is negative. The fluid collection is: | A. Most likely not an anastomotic leak | 10 |
| B. Most likely an anastomotic leak | 25 | |
| Can an asymptomatic patient with a perfectly healed anastomosis at two weeks (i.e., normal endoscopy/barium enema/computed tomography (CT) scan) develop a delayed leak: | A. Yes | 23 |
| B. No | 12 | |
| Current Research | ||
| Experimental animal research on anastomotic leak over the last decade has: | A. Improved our understanding and clinical management of anastomotic leaks | 1 |
| B. Provided little insight into the real biologic mechanisms of clinical leaks | 9 | |
| C. Provided some new insight but it has not changed the management of clinical leaks | 15 | |
| Current experimental animal models of anastomotic leak: | A. Are useful and should continue | 26 |
| B. Are useful but more large animals models (e.g., dogs, pigs, monkeys) should be used | 4 | |
| C. Are useless because they do not reflect the clinical circumstances of leaks | 5 | |
| Research into the pathogenesis of anastomotic leak could be advanced markedly by: | A. Focusing on devices (i.e., sutures, stapler, stents) | 0 |
| B. Developing more appropriate animal models that mimic clinical leakage | 3 | |
| C. Performing more analysis (i.e., oxygen, pH, collagen) on human anastomotic tissues during and after surgery | 32 | |
| Intestinal microbes as initiating and causative agents in anastomotic leak: | A. Have been investigated sufficiently, but likely only play a secondary role in leak | 2 |
| B. Have been investigated sufficiently, and likely play an important and causative role in leak | 6 | |
| C. Have been investigated insufficiently and requires further study | 27 | |
| Future Directions | ||
| Over the last decade, industry research and product development has contributed significantly to reducing the incidence of anastomotic leak: | A. Agree | 14 |
| B. Disagree | 21 | |
| Current industry research and product development (e.g., improved staplers, stents, glues) will have a significant impact on anastomotic leak rates in the near future: | A. Agree | 12 |
| B. Disagree | 23 | |
| If you were given $5 million to develop and execute research on intestinal anastomotic leak, you would: | A. Study the biology of anastomotic healing in large animals and develop biologic agents (e.g. growth factors, stem cells, angiogenesis) to prevent leakage | 11 |
| B. Perform clinical studies and analyze anastomotic tissues directly to define and characterize the biologic variables that are associated with anastomotic healing versus leakage. | 24 | |
| C. Develop novel devices to reduce leakage (e.g. stents, antibiotic-coated suture, absorbable staples, new staplers) | 0 | |
| With properly funded and properly focused research performed over the next three years, the incidence of anastomotic leaks in high-risk areas can be decreased by >50%: | A. Agree | 11 |
| B. Disagree | 24 | |
| If we could measure blood flow, oxygen status, microbial content, and collagen synthesis at anastomotic sites, the biggest impact on anastomotic leak would occur by: | A. Measuring parameters immediately after an anastomosis is created allowing surgeons to refine our surgical technique | 10 |
| B. Serially measuring parameters days and weeks after an anastomosis is created, allowing surgeons to understand why a given anastomosis heals or leaks | 25 | |