{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:47:20Z","timestamp":1787014040162,"version":"build-2736575974"},"reference-count":46,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,5,18]],"date-time":"2019-05-18T00:00:00Z","timestamp":1558137600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>\n                      The transanal approach to total mesorectal excision (Ta\n                      <jats:styled-content style=\"fixed-case\">TME<\/jats:styled-content>\n                      ) as an alternative to conventional anterior resection offers an improved view to otherwise restricted anatomical regions in obese and narrow male pelves and unfavourable tumour locations. Guidelines for the management of anastomotic leakage (\n                      <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content>\n                      ) following low rectal resections are scarce.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>\n                      Prospectively collected data of all consecutive patients undergoing Ta\n                      <jats:styled-content style=\"fixed-case\">TME<\/jats:styled-content>\n                      between December 2014 and April 2017 in our centre were analysed retrospectively. Existing classification systems for\n                      <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content>\n                      were modified with regard to transanal anastomotic\u2010preserving management.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ta\n                      <jats:styled-content style=\"fixed-case\">TME<\/jats:styled-content>\n                      was performed in 66 patients with a median age of 56.2\u00a0years. The overall incidence of\n                      <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content>\n                      was 12.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a08).\n                      <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content>\n                      grading was differentiated in Grades I to V according to the severity of necrosis and abscess development. Two patients suffered from\n                      <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content>\n                      Grade\n                      <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>\n                      , one patient from Grade\n                      <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n                      , three patients from Grade\n                      <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n                      and two patients from Grade V. Preservation of the anastomosis following\n                      <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content>\n                      was achieved by the damage control concept in six of eight patients (75%) with a median duration of hospital stay of 36\u00a0days. Two patients received a Hartmann procedure (Grades\n                      <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n                      and V).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Our study demonstrates that management of\n                      <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content>\n                      following Ta\n                      <jats:styled-content style=\"fixed-case\">TME<\/jats:styled-content>\n                      is challenging but definitely amenable to strategies aimed at preserving the anastomosis by appropriate damage control. The modified classification system might serve as guidance for anastomosis\u2010preserving management.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.14635","type":"journal-article","created":{"date-parts":[[2019,4,6]],"date-time":"2019-04-06T20:09:01Z","timestamp":1554581341000},"page":"894-902","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Anastomotic leak after transanal total mesorectal excision: grading of severity and management aimed at preservation of the anastomosis"],"prefix":"10.1111","volume":"21","author":[{"given":"S.","family":"Guel\u2010Klein","sequence":"first","affiliation":[{"name":"Department of Surgery Campus Charit\u00e9 Mitte and Campus Virchow Klinikum Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin Corporate Member of Freie Universit\u00e4t Berlin Humboldt\u2010Universit\u00e4t Berlin and Berlin Institute of Health Berlin 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