EP504 - Surgeon Preferences and Practice Patterns in Left-Sided Colorectal Anastomosis

Purpose/Background: Left-sided colorectal resections with anastomosis are common procedures that vary widely in technique and technology use. Understanding real-world practice patterns can help identify opportunities for standardization and innovation to improve outcomes.

Methods/Interventions: A 36-item electronic survey was distributed to general and colorectal surgeons through professional societies, peer networks, and social media. The survey assessed demographics, operative approaches, device preferences, intraoperative adjunct use, and perceptions of anastomotic leak risk. Responses were analyzed using descriptive statistics.

Results/Outcomes: 139 surgeons completed the survey. Most respondents practiced in community-based settings (67%) and had completed colorectal fellowship training (71%). Robotic intracorporeal anastomosis was frequent, indicating a shift toward fully minimally invasive workflows. Most surgeons used Ethicon or Medtronic circular staplers, with 28-29 mm the most common size. Device satisfaction was high (mean 4.1/5), although 77% reported a stapler-related complication in the prior year. Surgeons most often attributed leaks to tissue tension (81%), ischemia (83%), and tissue thickness (36%), rather than to stapler performance. Leak testing was performed by all respondents, with flexible sigmoidoscopy (52%) and air insufflation (41%) as the most frequent methods. Indocyanine green fluorescence imaging was used by 80% of respondents to assess perfusion. Seventy-two percent expressed interest in adopting new anastomotic technologies if this would improve outcomes.

Conclusion/Discussion: Robotic intracorporeal anastomosis is now a dominant practice pattern in left-sided colorectal resections. Surgeons report high device satisfaction but believe leaks are driven by technical and patient factors rather than stapler design. Leak testing and perfusion assessment are nearly universal but remain non-standardized. These findings highlight both the progress and variability in current practice and highlight the need for evidence-based workflows for innovation in colorectal surgery.

Table 1: Operative Platform and Workflow Patterns
Table 2: Leak Testing, Adjunct Use, and Innovation Interest.