|
Back to 2017 Program and Abstracts
ENDOLUMINAL VACUUM THERAPY AS A SALVAGE THERAPY AFTER RECTAL ANASTOMOTIC LEAK
Pierpaolo Sileri*1, Mostafa Shalaby1,2, Gabriella Giarratano3, Giorgio Lisi1, Elena Aronadio1, Giovanni Milito1
1University of Rome Tor Vergata, Rome, Italy; 2Department of General Surgery , Mansoura University , Mansoura , Egypt; 3Department of General Surgery, Villa Tiberia Hospital, Rome, Italy
Background:
Anastomotic leakage jeopardizes colorectal surgery with increased morbidity, mortality, and risk of a permanent stoma.
Over the last decade Weidenhagen et al. described a polyurethane sponge vacuum assisted drainage in treating the presacral abscess. We report our experience with Endoluminal vacuum therapy (EVT) as a salvage therapy for the anastomosis.
Methods and Materials:
After the diagnosis of anastomotic leakage has been confirmed the EVT therapy was started. Before application of EVT, any pelvic collections were drained surgically or percutaneously under radiological guidance.
The procedure
First, the abscess cavity was irrigated with physiological saline, and the size of the cavity was determined by the aid of colonoscopy. The sponge was tailored according to the cavity size and moistened with the lubricant, then compressed and introduced through the introducer sleeve with aid of the pusher. Then, the sponge was advanced into the cavity and was placed up to the far end of the cavity. The introducer sleeve then was withdrawn over the pusher.
Finally, the sponge was fully deployed in the cavity connected to the evacuation tube. The evacuation tube coming out trans-anal was connected to a negative suction device.
Follow-up
The sponge changed every 2-3 days in the same way of application. The success of the EVT therapy was defined by cavity closure confirmed by endoscopy.
Results:
Twenty-one patients with anastomotic leakage after anterior resection for rectal cancer between January 2005 and November 2016 were suitable for EVT.
All patients had anastomosis within median 8 cm (range; 4-12 cm) from anal verge with fecal diversion created at the initial surgery. Leakages were confirmed by CT with rectal contrast after a median of 8 days (range; 3-42 days).
Before the application of EVT any pelvic collection was drained, in 4 patients surgically and in 12 under radiological guidance.
Mean EVT duration therapy was 28 days (range; 6-87 days) with a median number of 4 sponge per patient (range; 1-14 sponge).
Two patients (9.5%) experienced complications, cavity bleeding (1) and anastomotic stenosis (1). Therapy was continued and tolerated in all patients except in two patients. One patient who developed bleeding and in one patient with a biopsy proved a recurrent carcinoma.
One patient died. The success of the EVT was confirmed in all remaining 18 with a success rate of 86%. All stomas were reversed in the remaining patients.
Conclusions:
Endoluminal Vacuum Therapy, with the proper indication and application, allows anastomotic salvage within a relatively short period of time, thus reducing the impact of a permanent stoma and its related complications, and psychological impact on patients.
EVT is safe, easily applicable, and well tolerated by patients.
Back to 2017 Program and Abstracts
|
