Endoscopic vacuum therapy of anastomotic leaks complicating colorectal surgery

Aims Anastomotic leak is a common complication (4-15%) of colorectal surgery. Endoscopic vacuum therapy (EVT) is an innovative technique based on continuous negative pressure, leading to improved drainage and closure of the cavity. The aim of this study is to evaluate feasibility and efficacy of EVT to treat anastomotic leaks after colorectale surgery.

Methods Retrospective study in 2 university centers including all patients referred for EVT from 2015 to 2022. A gastroscope was introduced up to the rectal anastomosis and into the para-anastomotic cavity under general anesthesia. The overtube was then inserted into the cavity and the sponge was positioned through the overtube into the cavity. A continuous negative pressure pump was connected to the sponge. The sponge needed to be replaced every 3 to 4 days until the cavity was reduced to less than 10 mm.

Results A total of 30 patients underwent rectal EVT during the study period. Among them, 23 patients were included (30% females, mean age 65±9 years). Technical success with complete closure was achieved in 19/23 patients (83%), among them 16/23 (70%) without additional surgical intervention. In total 160 endoscopic procedures were performed with a mean of 7 sponge replacements. In 9/23 patients (40%) patients were treated on an ambulatory base. Adverse events rate was 22% (6/27 patients) without procedure-related mortality. Clinical success rate was 70% (16/23) at 1 month.

Conclusions EVT is feasible and efficient to treat anastomotic leaks with pelvic collections after colorectal surgery. It can also lead to a more healthier pelvic environment to improve redo surgery outcome.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023