ENDOSCOPIC VACUUM THERAPY (EVT) FOR TREATMENT OF ANASTOMOTIC DEHISCENCE AFTER COLORECTAL SURGERY

Aims Anastomotic dehiscence after colorectal surgery is a severe complication. EVT is a promising therapeutic approach. The primary endpoint of this study was to analyze efficacy and feasibility of EVT in the management of anastomotic leakage after colorectal surgery.

Methods This is a prospective single-center study evaluating all consecutive patients referred for anastomotic dehiscence after colorectal surgery. Exclusion criteria were small cavity (< 1 cm) or circumferential defect. EVT procedures were performed according to product technical sheet. After a mean 3-days interval, the sponges were replaced until healing process started. Clinical success was defined as disappearance of anastomotic leakage. Treatment failure was defined as persistence of cavity.

Results 14 patients were evaluated between October 2017 and April 2019: 2 were excluded (< 1 cm defect). 12 patients (M=11) (median age 70 - range 40-86 yo) were included. Indications for EVT were Hartmann´s stump insufficiency (n=6), anastomotic leakage after Laparoscopic Total Mesorectal Excision (Lap-TME) (n=3) and anastomotic dehiscence after Trans-anal Total Mesorectal Excision (TaTME) (n=3). A total of 169 sponges were placed in 12 patients with a median number of 12,5 per patient (range 4-31). Overall, clinical success was achieved in 7 (58.3%) in a median of 97 days (range, 15-160). 4 patients had an initial healing process followed by a subsequent deterioration requiring EVT reinsertion: 1 patient finally had a full resolution, 1 had a treatment failure, while 2 died during EVT for neoplastic progression (1) and septic complications (1). The remaining 2 patients had a treatment failure. No complications were recorded. Stratifying, patients with an acute dehiscence (< 3 months) obtained a full resolution in 80% (8/10); while patients with a chronic one never reached it (0/4), even if not statistically significant.

Conclusions EVT seems a feasible and safe treatment for colorectal anastomotic dehiscence and represents a minimally invasive alternative to surgical re-treatment.