Endoscopic vacuum therapy for treatment of large distal anastomotic dehiscence after colorectal surgery

Rodrigo Mansilla-Vivar; Sebastian Manuel Milluzzo; Eugenia Vittoria Pesatori; Paola Cesaro; Alessandra Bizzotto; Mauro Lovera; Nicola Olivari; Cristiano Spada; Eduardo Segovia

doi:10.47892/rgp.2024.443.1704

Autores/as

Rodrigo Mansilla-Vivar Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; Digestive Endoscopy Unit, Puerto Montt Hospital, Puerto Montt, Chile; Facultad de Medicina y Ciencia, Universidad San Sebastián, sede de La Patagonia, Puerto Montt, Chile. https://orcid.org/0000-0001-5320-9981
Sebastian Manuel Milluzzo Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro Cuore, Rome, Italy. https://orcid.org/0000-0002-6786-1783
Eugenia Vittoria Pesatori Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro Cuore, Rome, Italy.
Paola Cesaro Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy. https://orcid.org/0000-0003-0899-9034
Alessandra Bizzotto Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
Mauro Lovera Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
Nicola Olivari Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy. https://orcid.org/0000-0001-5004-3621
Cristiano Spada Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro Cuore, Rome, Italy. https://orcid.org/0000-0002-5692-0960
Eduardo Segovia Facultad de Medicina y Ciencia, Universidad San Sebastián, sede de La Patagonia, Puerto Montt, Chile. https://orcid.org/0009-0004-5475-3400

DOI:

https://doi.org/10.47892/rgp.2024.443.1704

Palabras clave:

Fuga anastomótica, Dehiscencia de la herida operatoria, Cirugía colorrectal, Endoscopía

Resumen

Background: Management of anastomotic dehiscences following colorectal surgery is a topic of debate. In this context, endoluminal vacuum therapy offers promising results. Objective: To analyze the efficacy and feasibility of endoluminal vacuum therapy in distal anastomotic dehiscences after colorectal surgery. Materials and methods: This study is a descriptive case series that evaluates patients with anastomotic dehiscences over a period of 18 months. All patients were treated with Endo-sponge™ (Braun Medical, Hessen, Germany). Results: Fourteen patients were included in the final analysis. The indications for endoluminal vacuum therapy were Hartmann's stump insufficency (n=6), anastomotic leakage after laparoscopic total mesorectal excision (n=4), and anastomotic dehiscence after transanal total mesorectal excision (n=4). A total of 204 sponges were placed per patient (median 12.5, range 1-33). Complete resolution was achieved in 9 patients (57.1%) in a mean time of 108 days (range 15-160 days). In the sub-analysis, patients with acute dehiscence (<3 months) achieved complete resolution in 80% (8/10), whereas no patient with chronic defects reached resolution (0/4). A low complication rate (7%) was recorded. Conclusion: Endoluminal vacuum therapy appears to be a feasible and safe treatment with a high success rate in patients with large acute colorectal anastomotic defects.

Descargas

Los datos de descargas todavía no están disponibles.

Métricas

Cargando métricas ...

Citas

Phitayakorn R, Delaney CP, Reynolds HL, Champagne BJ, Heriot AG, Neary P, et al. Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg. 2008;32(6):1147-56. doi: 10.1007/s00268-008-9468-1.

Soeters PB, de Zoete JPJGM, Dejong CHC, Williams NS, Baeten CGMI. Colorectal surgery and anastomotic leakage. Dig Surg. 2002;19(2):150-5. doi: 10.1159/000052031.

Blumetti J, Chaudhry V, Cintron JR, Park JJ, Marecik S, Harrison JL, et al. Management of anastomotic leak: Lessons learned from a large Colon and Rectal Surgery training program. World J Surg. 2014;38(4):985-91. doi: 10.1007/s00268-013-2340-y.

Mees ST, Palmes D, Mennigen R, Senninger N, Haier J, Bruewer M. Endo-vacuum assisted closure treatment for rectal anastomotic insufficiency. Dis Colon Rectum. 2008;51(4):404-10. doi: 10.1007/s10350-007-9141-z.

Mileski WJ. Treatment of anastomotic leakage following low anterior colon resection. Arch Surg. 1988;123(8):968. doi: 10.1001/archsurg.1988.01400320054011.

Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis. 2009;24(6):711-23. doi: 10.1007/s00384-009-0660-z.

den Dulk M, Smit M, Peeters KC, Kranenbarg EM-K, Rutten HJT, Wiggers T, et al. A multivariate analysis of limiting factors for stoma

reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol. 2007;8(4):297-303. doi: 10.1016/s1470-2045(07)70047-5.

Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch K-W. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc. 2008;22(8):1818-25. doi: 10.1007/s00464-007-9706-x.

Verlaan T, Bartels SAL, van Berge Henegouwen MI, Tanis PJ, Fockens P, Bemelman WA. Early, minimally invasive closure of anastomotic leaks: a new concept. Colorectal Dis. 2011;13(s7):18-22. doi: 10.1111/j.1463-1318.2011.02775.x.

Strangio G, Zullo A, Ferrara EC, Anderloni A, Carlino A, Jovani M, et al. Endo-sponge therapy for management of anastomotic leakages after colorectal surgery: A case series and review of literature. Dig Liver Dis. 2015;47(6):465-9. doi: 10.1016/j.dld.2015.02.007.

Nerup N, Johansen JL, Alkhefagie GA, Maina P, Jensen KH. Promising results after endoscopic vacuum treatment of anastomotic leakage following resection of rectal cancer with ileostomy. Dan Med J. 2013;60(4):A4604.

Blot C, Sabbagh C, Rebibo L, Brazier F, Chivot C, Fumery M, et al. Use of transanastomotic double-pigtail stents in the management of grade B colorectal leakage: a pilot feasibility study. Surg Endosc. 2016;30(5):1869-75. doi: 10.1007/s00464-015-4404-6.

Loske G, Müller C. Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc. 2009;69(3):601-2. doi: 10.1016/j.gie.2008.06.058.

Loske G, Müller CT. Tips and tricks for endoscopic negative pressure therapy. Chirurg. 2019;90(S1):7-14. doi: 10.1007/s00104-018-0725-z.

Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2013;148(1):65. doi: 10.1001/2013.jamasurg.2.

van Koperen PJ, van Berge Henegouwen MI, Rosman C, Bakker CM, Heres P, Slors JFM, et al. The Dutch multicenter experience of the Endo-Sponge treatment for anastomotic leakage after colorectal surgery. Surg Endosc. 2009;23(6):1379-83. doi: 10.1007/s00464-008-0186-4.

Kuehn F, Janisch F, Schwandner F, Alsfasser G, Schiffmann L, Gock M, et al. Endoscopic vacuum therapy in colorectal surgery. J Gastrointest Surg. 2016;20(2):328-34. doi: 10.1007/s11605-015-3017-7.

Keskin M, Bayram O, Bulut T, Balik E. Effectiveness of endoluminal vacuum-assisted closure therapy (endosponge) for the treatment of pelvic anastomotic leakage after colorectal surgery. Surg Laparosc Endosc Percutan Tech. 2015;25(6):505-8. doi: 10.1097/sle.0000000000000216.

Arezzo A, Verra M, Passera R, Bullano A, Rapetti L, Morino M. Long-term efficacy of endoscopic vacuum therapy for the treatment of colorectal anastomotic leaks. Dig Liver Dis. 2015;47(4):342-5. doi: 10.1016/j.dld.2014.12.003.

Fuentes CF, Córdoba Guzmán AC, Daza Castro EM, Aponte D, González C, Sabbagh LC. Terapia E-VAC como tratamiento de complicaciones en cirugía gastrointestinal en centro de referencia de gastroenterología en Colombia: Serie de casos. Rev Gastroenterol Peru. 2023;43(2):e1472. doi: 10.47892/rgp.2023.432.1472.

McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102(5):462-79. doi: 10.1002/bjs.9697.

Ramirez Barranco R, Cañadas Garrido RA, Cáceres Escobar D. Terapia de vacío endoluminal (Endo-Vac) en el manejo de la fístula de anastomosis esofagogástrica. Rev Colomb Gastroenterol. 2022;37(1):83-9. doi: 10.22516/25007440.710.

Shalaby M, Emile S, Elfeki H, Sakr A, Wexner SD, Sileri P. Systematic review of endoluminal vacuum-assisted therapy as salvage treatment for rectal anastomotic leakage. BJS Open. 2019;3(2):153-60. doi: 10.1002/bjs5.50124.