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Endo-Vac Treatment for Rectal Anastomotic Insufficiency
Soeren Torge Mees*, Daniel Palmes, Rudolf Mennigen, Joerg Haier, Matthias Bruewer, Norbert Senninger, Dirk Tuebergen
General Surgery, University Hospital Muenster, Muenster, Germany

Background: Anastomotic insufficiency in patients with rectal anastomosis is a major complication with high morbidity and mortality. Local treatment with transrectal lavage and drainage can be considered in patient without peritonitis. In order to circumvent prolonged wound closure and secondary complications during conservative treatment we investigated the vacuum assisted closure (VAC).
Methods: 10 patients with anastomotic insufficiency after colorectal resections, who did not require transabdominal interventions, were treated with an Endo-VAC dressing (group A; n=5) or by continous transrectal lavage and drainage (group B; n=5). In the first group a redovac system (redon-bottle with negative pressure of 100mbar) was used that was endoscopically inserted into the insufficiency cavity. Regularly, endoscopic controls were carried out until the cavity was completely closed. Time for wound healing, duration of hospitalisation and pain assessment were compared in both groups.
Results: The Endo-VAC treatment was carried out for an average treatment time of 24.6 ± 7.8 days without any VAC associated complications. A significantly accelerated wound healing was seen in patients treated with Endo-VAC compared to group B patients (wound closure after a mean of 47.4 d vs. 104.2 d, p<0.05). The postoperative hospitalisation was shortened for patients treated with Endo-VAC (33.6 ± 13.92 vs. 44.7 ± 7.96 days). The pain assessment in both groups did not show differences in score values. The Endo-VAC therapy resulted in a high acceptance of this therapy by all patients in this group.
Conclusion: Endo-VAC treatment for anastomotic insufficiency after colorectal resection can represent an effective method to achieve faster definitive wound healing with high patient comfort. The reduction of hospitalisation after Endo-VAC treatment appears to be an important economical aspect.

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