SSAT - "TUBE-IN-TUBE ENDOSCOPIC VACUUM THERAPY" (CR TT-EVT): A NOVEL APPROACH OF VACUUM THERAPY FOR COLORECTAL ANASTOMOTIC LEAKS

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"TUBE-IN-TUBE ENDOSCOPIC VACUUM THERAPY" (CR TT-EVT): A NOVEL APPROACH OF VACUUM THERAPY FOR COLORECTAL ANASTOMOTIC LEAKS
Ana Victoria M. Lima^*, Marcelo S. de Lima, Fernanda C. Franco, Cesar S. Quevedo Penaloza, Diego Cadena-Aguirre, Rafael S. Balbinot, Amanda A. Pombo, Andressa A. Machado, Bruno d. Martins, Carla C. de Oliveira, Caterina M. Pennacchi, Cesar C. de Clemente, Gustavo A. de Paulo, Luciano H. Tolentino, Renata N. Moura, Marina T. Ferreira, Sebastian N. Geiger, Pastor J. Mendieta, Ulysses Ribeiro, Adriana V. Safatle-Ribeiro, Fauze Maluf-Filho
Instituto do Cancer Doutor Arnaldo Vieira de Carvalho, Sao Paulo, S�o Paulo, Brazil

Introduction: Anastomotic leaks (AL) represent a severe adverse event after colorectal surgery. Despite improvements in mechanical sutures and surgical techniques, AL occur in 7-10% of colorectal surgeries with a 20-35% mortality rate. In the past decades, endoscopic vacuum therapy has emerged as a therapeutic alternative for closing these defects, preserving the colorectal anastomosis, and avoiding further surgical intervention or permanent stoma. Since 2001, vacuum therapy with a sponge placed at the tip of Levine tube has been successfully used transanally, either endoluminally or intracavitary. In 2017, Tube-in-Tube Endoscopic Vacuum Therapy (TT-EVT) technique was described (doi: 10.1111/codi.16577). It allows transanal and/or transparietal installation, by endoscopic or surgical approach, without sponges as well as cavity irrigation, which may contribute to better infection control and faster healing process. Furthermore, there is no need of frequent endoscopic sessions, reducing costs and making it more accessible.

Objectives: To evaluate technical success, clinical success, and adverse events of CR TT-EVT.

Methods: A retrospective study conducted at a reference oncological center, evaluating patients with colorectal anastomotic leaks treated with CR TT-EVT between 2019 and 2024.

Results: Among the 19 patients diagnosed with colorectal AL, 15 underwent surgery for colorectal cancer, three for diverticulitis, and one for endometriosis. Thirteen were male, with a mean age of 58 years. All but two patients underwent endoscopic vacuum therapy using the CR TT-EVT method, two of them required laparoscopic intervention for placement. In eight patients CR TT-EVT was performed as primary treatment, and 11 as rescue therapy after the failure of other treatments. The treatment access route was predominantly transparietal, performed in 13 patients (68.4%), while five had a transanal access route and one via colostomy. Twelve patients (63.1%) had a protective stoma. The median time from the initial procedure to the diagnosis of AL was eight days. Also, the median time between AL diagnosis and TT-EVT placement was eight days. Technical success rate was achieved in all cases. The median duration of therapy was 21 days, and in 3 patients (15.7%) a over-the-scope clip was used to achieve AL resolution. Clinical success rate was 89.4%, and displacement of the vacuum tube occurred in 36.8% of the patients. Adverse events associated with the CR TT-EVT method were observed in three patients, who developed anastomotic stenosis, which was resolved with dilation. There were no deaths.

Conclusions: 1. Despite device displacement and stenosis, CR TT-EVT method proved to be safe and effective, irrespective of the approach used, whether endoscopic or surgical; 2. CR TT-EVT method appears to be a promising alternative for resolving anastomotic leaks.

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