Table 1 Protocol of multimodal fail-safe approach for colorectal resections in our study

Preoperative settings

 Bowel preparation (for right-, left-sided, and rectal resections)

O

 Preoperative intravenous antibiotics

O

Operative approach/technical aspects

 Experienced colorectal surgeon

O

 Complete mobilization of the hemicolon for tension-free anastomosis

O

 Bleeding/perfusion test at the edge of the resection margin

O

 Side-to-side anastomosis

  - Continuous seromuscular suture

O

  - Additional seams on the edges to relieve tension on the anastomosis

O

 End-to-end anastomosis

  - Mesentery is in line with the resection margin

O

  - Do not free endings from fatty tissue

O

  - Avoid sharp-angled edges

O

  - Stretching of the anal sphincteric muscle for three minutes

O

  - Spine of the stapling device next to the stapled line

O

  - After joining ends, compression for at least one minute before release

O

  - Anastomotic assessment using sigmoidoscope (air test + intraluminal inspection)

O

  - Diverting stoma for low rectal anastomosis

O

  - On-table lavage over efferent loop of ileostomy with 5L of saline

O

  - Placement of a drainage tube near the anastomosis

O

Postoperative settings

  - A 3-day low-volume high-calorie nutrition (except patients with diverting stoma)

O

  - Full meals from 4^th postoperative day onwards

O

  - Endoscopic control of colorectal-/coloanal anastomosis on 4^th postoperative day

O

  - In case of suspected anastomotic leakage, over-the-scope-clip application

O