Aims Anastomotic leakage is a serious complication following colorectal surgery and is
associated with early and long-term morbidity and mortality. Various endoscopic and
surgical approaches have been established for management. A new therapeutic option
involves the placement of a fully covered VACStent for the lower GI tract (36x80 mm,
MICRO-Tech, Düsseldorf, Germany) which offers advantages such as completely covering
the defect, continuous drainage, and facilitating stool passage simultaneously. Here
we report our initial experiences with the VACStent in the lower GI tract for treatment
of anastomotic leakage.
Methods The fully covered VACStent (36x80 mm) was placed endoscopically under direct visualization.
A continuous negative pressure between -75 and -125 mmHg was applied. The VACStent
was flushed daily with 20 ml of saline to prevent adhesions of the open-pored sponge
of the stent. Six hours before the stent extraction/exchange, the negative pressure
was discontinued. The integrity of the leak closure was confirmed visually and via
fluoroscopy.
Results Between February and November 2024, we treated five patients with anastomotic leakage
(rectal leakage n=3, sigmoid leakage n=2) using the VACStent. The leak was detected
on the 7th±3 postoperative day. The leak was successfully sealed with the VACStent and one to
two exchanges were performed. The leak closure occurred after 16±3 days, with inflammatory
parameters decreasing by around 83±12%. Four patients received a protective stoma.
The distance of the leak from the anal canal averaged 9±8 cm. Patients with leaks
involving the anal canal required pain relief. One patient experienced point-shaped
erosion bleeding in the anal canal, which was effectively treated with APC.
Conclusions The lower GI VACStent represents a novel promising and effective endoscopic treatment
option for colonic anastomotic defects.
