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Endoscopic Vacuum Therapy in Colorectal Surgery
Florian Kuehn^*, Florian Janisch, Frank Schwandner, Michael C. Gock, Ernst Klar

Dept. of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany

Introduction: Since the first larger studies in the late 1990s, vacuum assisted closure therapy has become popular in nearly every field of surgery. Endoscopic vacuum therapy (EVT) has been established in Germany for the treatment of anastomotic leakage after rectal resection. The principles of VAC therapy remain the same no matter of localization: Continuous or intermittent suction and drainage via an open-pored polyurethane sponge decrease bacterial contamination, secretion, and local edema. At the same time perfusion and granulation is promoted. However, data for use and long term results of EVT in colorectal surgery are still scarce and consist of only a few small patients series with short-term follow-up.
Objectives: Here, we aimed to analyze treatment spectrum and outcome of EVT for defects of the lower gastrointestinal tract.
Methods: Retrospective single center analysis of EVT for various defects of the lower gastrointestinal tract over a time period of 8 years (2007-2014) with a mean follow-up of 36 months.
Results: In total, 426 polyurethane sponges were placed in lower GI defects of 38 patients (29 male, 9 female) with a median age of 67 years (range, 29-91). Most frequent indication for EVT were anastomotic leakage after rectal resection (n=18), Hartmann's stump insufficiency (n=9) and rectal perforation (n=3). The median number of sponge insertions was six (range, 1-37) with a mean changing interval of three days (range, 1-5). Median time of therapy was 20 days. A successful vacuum therapy with local control of the septic focus was achieved in 17 of 18 patients (94.4%) with anastomotic leakage after rectal resection and in 8 of 9 patients with a Hartmann`s stump insufficiency.
Conclusion: EVT has earned its indication in complication management after colorectal surgery and can achieve a successful control of a local septic focus in the majority of patients.

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