{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:28:44Z","timestamp":1792290524106,"version":"4.4.0"},"reference-count":32,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We aimed to identify risk factors associated with chronic anastomotic leak (AL) treatment failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult patients surgically treated for chronic AL after colorectal or coloanal anastomosis for benign and malignant indications were included. The primary outcome was predictors of AL treatment failure, defined as failure to restore bowel continuity and\/or having a permanent stoma at completion of treatment. Step-wise multivariable logistic regression analysis of factors that reached statistical significance on univariable analyses was undertaken.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      60 patients [41 (68.3%) males; average age: 56 (SD 6.7) years; and average BMI: 24 (SD 2.1) kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ] were included. 61% of patients were referred for treatment; 46 (76.7%) had colorectal and 14 (23.3%) had coloanal anastomosis at index surgery. 38 (63.3%) had successful treatment; 22 (36.7%) required permanent stoma. Patients who failed treatment on univariable analysis were likely older (OR 1.06;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.045), had &gt;2 prior attempted AL treatments (OR 9.53;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.042), and end colostomy at AL surgery (OR 25.4;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.032). Predictors of failed treatment of chronic AL on multivariable analysis were older age and\n                      <jats:underline>&gt;<\/jats:underline>\n                      2 prior treatments.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>More than 1\/3 of patients with chronic AL eventually fail to achieve restored intestinal continuity. Risk factors on multivariable regression are &gt;2 treatments for chronic AL before definitive therapy and older age at treatment. We recommend considering redoing the anastomosis earlier in the treatment of chronic AL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251337163","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T07:53:31Z","timestamp":1745481211000},"page":"1492-1502","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Repeated Treatments for Chronic Colorectal and Coloanal Anastomotic Leaks are Associated With a Higher Chance of a Permanent Stoma"],"prefix":"10.1177","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1809-7651","authenticated-orcid":false,"given":"Justin","family":"Dourado","sequence":"first","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameh Hany","family":"Emile","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA"},{"name":"Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjelli","family":"Wignakumar","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Weiss","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Horesh","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA"},{"name":"Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"DeTrolio","sequence":"additional","affiliation":[{"name":"American University of the Caribbean, Cupecoy, St. Maarte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Gefen","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA"},{"name":"Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Garoufalia","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic 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