EVAC THERAPY FOR RECTAL ANASTOMOTIC LEAKS AND PERFORATION

Aims Rectal perforation and anastomotic leaks or fistula occurring after colorectal surgery are difficult to treat situation burdened by considerable morbidity, costs and highly stressful for the patient. The incidence of anastomotic leakage reaches 24%of patients undergoing colorectal surgery. Near a quarter of these result in a permanent intestinal stoma. Small leakages are usually managed endoscopically. However, in most of cases diagnosis is delayed and leakages are wider, leading to perineal collection with possible serious complications requiring invasive procedure and surgical re-intervention. In this patients, endovac therapy (Endo-SPONGE; B. Braun Medical) represents a minimally invasive option to treat post surgical leak or rectal traumatic perforation

Methods From 2011 to september2019, we retrospectively reviewed 40 patients(31 male) treated with evac therapy in our hospital for post surgical anastomotic leakage in 36 of them (29 for cancer, 5 for acute diverticulitis, 2 for inflammatory bowel disease) and for rectal traumatic perforation in 4.

Results Following evac treatment, a complete healing of leakage was achieved in 34(85%). Overall, restoration of bowel continuity was possible in 32 patients(80%). The sponge was changed a median number of 8(range 4-22)and the median treatment duration was 32 days(range 18-60). Complications were reported in two patients. In one case there was a serious bleeding due to artery erosion. In the second patient a small bowel fistula occurred required a surgical re-intervention. In six patients evac therapy showed lack of efficacy and all of them were in the post surgical anastomotic leakage group, one underwent to Hartmann procedure for acute diverticulitis with sigmoid perforation and 5 were previously chemo and radio treated for locally advanced rectal cancer.

Conclusions In this large series, evac treatment with Endo-sponge has showed good effectiveness and safety both in patient with post surgical anastomotic leaks and rectal perforation, reducing the need of re intervention and major surgery