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

Authors

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

Keywords:

Anastomotic leak, Surgical wound dehiscence, Colorectal surgery, Endoscopy

Abstract

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.

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