Introduction:
The number of sphincter-preserving rectal surgeries has increased, but at the cost of a parallel increase in anastomotic leaks (AL). Endoluminal vacuum therapy (EVT) emerges as a viable solution, averting the need for surgical reinterventions.
Objectives:
Primary: To assess the efficacy of EVT (defined as AL complete closure) and the rate of patients undergoing restoration of bowel continuity.
Secondary: To evaluate adverse events, treatment duration, and AL recurrence.
Material:
Single-center retrospective study, encompassing all patients undergoing EVT for colorectal and ileoanal AL (10/2017 to 10/2023). Analyzed factors include demographics, type of surgery, duration of EVT treatment, adverse events, and AL recurrences.
Results:
Twenty patients included; age range 18-77 (median 59); males: 14/20.
Ileoanal anastomoses (prophylactic surgery for Familial Adenomatous Polyposis): 3/20;
Colorectal anastomoses (anterior resections for adenocarcinoma): mid-rectum 9/17; low rectum 7/17;
Neoadjuvant therapy: 13/17; Protective stoma: 18/20;
Postoperative day at AL diagnosis(median): 10.5 (1-379); Days until EVT start (median): 8.5 (0-681).
Leak maximal dimension (median): 50mm (20-120mm).
Number of EVT sessions (median): 9 (2-17) ; EVT with 2 sponges: 3/20 patients; other local therapies: 11/20 (9 TTS clips; 1 OTSC; 1 transanal suture).
Primary efficacy (endoscopic+radiologic leak closure): 14/19 (74%; 1/20 still pending reassessment). 1/14 patients is pending reconstruction surgery. 11/13 underwent restoration of bowel continuity (1 patient refused surgery; 1 patient had disease progression).
9/11 patients proposed for adjuvant treatment completed the treatment.
AL relapses: 2/11. Adverse events: 2/20 (1 sponge migration, 1 enteric fistula).
Conclusions:
For colorectal and ileoanal AL, EVT demonstrated safety and high efficacy, promising a positive impact on patient quality of life by enabling restoration of bowel continuity. The use of other local therapies contributed to the positive outcomes.
