Endoscopy 2025; 57(S 02): S171
DOI: 10.1055/s-0045-1805430
Abstracts | ESGE Days 2025
Oral presentation
Interventional colonoscopy from resection to beyond! 05/04/2025, 12:00 – 13:00 Room 114

VACStent-treatment of anastomotic leakages in colorectal surgery – a prospective registry study

Authors

  • A Yohannes

    1   Klinik für Gastroenterologie, Kliniken der Stadt Köln, Cologne, Germany

  • M Heiss

    2   Klinik für Viszeral-, Tumor-, Transplantations- und Gefäßchirurgie, Kliniken der Stadt Köln, Cologne, Germany

  • J Lange

    2   Klinik für Viszeral-, Tumor-, Transplantations- und Gefäßchirurgie, Kliniken der Stadt Köln, Cologne, Germany

  • J Knievel

    2   Klinik für Viszeral-, Tumor-, Transplantations- und Gefäßchirurgie, Kliniken der Stadt Köln, Cologne, Germany

  • U Hügle

    1   Klinik für Gastroenterologie, Kliniken der Stadt Köln, Cologne, Germany

  • A Dormann

    1   Klinik für Gastroenterologie, Kliniken der Stadt Köln, Cologne, Germany

  • C Eisenberger

    2   Klinik für Viszeral-, Tumor-, Transplantations- und Gefäßchirurgie, Kliniken der Stadt Köln, Cologne, Germany
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Aims Clinical applications of the VACStent in the upper GI tract show that reliable closure of an intestinal wall leak or anastomotic insufficiency with simultaneous drainage of a wound cavity using intraluminal endoscopic vacuum (EVT) is very possible. By suctioning the sponge cylinder onto the bowel wall, the VACStent is reliably immobilised and the bowel passage remains open. The principle of endoluminal vacuum therapy with the VACStent is now also being transferred to the lower GI tract to treat anastomotic insufficiency while avoiding a stoma.

Methods Within the prospective VACStent registry study, 27 patients with colorectal resections have been treated with a total of 55 VACStents. In 12 out of 14 patients, the insufficiency was treated exclusively with the VACStent, without creation of a stoma. In 13 high-risk patients, the VACStent was implanted prophylactically directly after anastomosis creation.

Results The results show that the use of the VACStent in the lower GI tract is unproblematic and complications (migration, ulcers, haemorrhage) occurred in less than 5% of patients. Vacuum drainage at 80-125 mmHg has been installed in all patients to date. A significant result is that stool passage through the VACStent can be maintained without major problems under conditioning with Movicol and fibre-free food. The anastomosis healed in all patients after a median of 14 days (5-34 days) and 2 VACStents (1-5 VACStents). The prophylactic VACStent treatment lasted a median of 7 days with one VACStent. Secondary stoma creation or surgical revision was not necessary. Anastomotic stenosis has also not been observed to date.

Conclusions This experience shows that the VACStent is also firmly anchored in the colorectum due to the suction effect on the bowel wall, can cover anastomoses and heal insufficiencies. The open faecal passage makes it possible to heal an anastomosis even without the surgical creation of an anus praeter. This endoluminal anastomosis treatment and stoma avoidance has great clinical potential and must be further validated and tested in studies.



Publication History

Article published online:
27 March 2025

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