45 Quality of reporting on anastomotic leaks in colorectal trials: A systematic review Table 2. Overview of definitions and timeframes used in the included studies. Definitions N = 44/95, 46% A defect of the intestinal wall at the anastomotic site (including suture and staple lines of neo-rectal reservoirs) leading to a communication between the intra- and extra-luminal compartments.* 25 (57%) Leak originating from staple/suture line 6 (14%) Incontinuity at the anastomotic site detected clinically or radiologically within 30-60 days after surgery 3 (7%) Anything other than a regular, uniform caliber at the level of the anastomosis 2 (5%) Other definitions** 12 (27%) Timeframe of AL diagnosis (after surgery) N = 39/95, 41% Within 7 days 1 Within 14 days 1 Within 30 days 24 > 30 days 1 Within 90 days 2 Within 12 weeks 1 Within 6 months 1 Within hospital stay 2 No time limit reported (> 6 months) 4 Systematic review reports different times for all included articles 2 Percentages are calculated based on number of publications reporting an element. *Definition according to ISREC, the International Study Group of Rectal Cancer; **See supplementary 2. Radiological modalities and elements Radiological modalities were specified in 63% (n = 60) of publications 20-22, 25-31, 36, 38-44, 46, 50, 53, 58, 61, 63, 64, 66, 68-72, 74-82, 85-87, 89, 91-93, 95-97, 99, 100, 102, 105-107, 109, 111, 113, 114. Most authors confirmed the suspicion of AL by computed tomography (CT) scan. In more than half of studies, the authors did not specify if the CT scan was performed with or without oral or rectal contrast. If specified, most of them used contrast enemas. Besides CT scans, endoscopic studies (e.g., sigmoidoscopy and rectoscopy) were used to assess AL. Other modalities used included X-ray with or without contrast, gastrograffin enema, ultrasound, magnetic resonance imaging (MRI), and positron emission tomography (PET). An abdominal or pelvic collection and/or abscess in the proximity of the anastomosis was the most frequently described imaging finding when diagnosing a leak. Extravasation of contrast, the presence of air or fluid around the anastomosis, and descriptions of anastomotic dehiscence, breakdown of any staple line, and an anastomotic defect were also used. Reoperations Findings at reoperation were described in 13% (n = 12) of the included publications 22, 27, 28, 53, 66, 76, 78, 93, 95, 97, 102, 105. The most frequently reported finding was visualization of anastomotic dehiscence and/or anastomotic defect at the time of reoperation. Other findings at reoperation were fistula formation and postoperative peritonitis. 2
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