TITLE:
Combined Endoscopic Transanal Vacuum-Assisted Rectal Drainage: A Novel Therapy for Colorectal Anastomotic Leak after TME for Cancer
AUTHORS:
Mario Martinotti, Valerio Ranieri, Elena Iiritano, Teresa Staiano, Roberto Dusi, Ernesto Laterza, Federico Buffoli
KEYWORDS:
Endosponge®, Colorectal Anastomotic Leak, Transanal Vacuum Therapy
JOURNAL NAME:
Surgical Science,
Vol.5 No.10,
October
22,
2014
ABSTRACT: Introduction: Low
colorectal and colo-anal anastomosis leakage after anterior resection of rectum
occurs in up to 24% of cases. Leak is the main cause of morbidity and mortality
in postoperative period and can result in a permanent stoma in up to 25% of
cases. Loop ileostomy or colostomy does not reduce the percentage of fistulas,
but reduces flow rate. Conservative management imply long times to heal.
Endosponge® system (B. Braun Aesculap AG, Germany) was recently acquired in
clinical practice. This system accelerates healing process through vacuum
creation, removal of fluids and edema, infection control, local increase of
blood flow and stimulation of granulation tissue formation. The device consists of a
cylindrical polyurethane sponge, with 400 to 600 micron pores, standard
dimension of 7 cm, which can be cut to fit the estimated size of the abscess
cavity. The drain tube is connected to a Redyrob Trans Plus®bottle which exerts
a constant suction during the therapy. Materials
and Methods: From November 2012 and March 2014 four patients were treated
with Endosponge® system, all of them underwent operation of anterior resection
of rectum for cancer and developed anastomotic leakage during postoperative
course. All patients had loop ileostomy, none presented signs of sepsis. The
Endosponge® system was then placed endoscopically. In all cases, after the
first placing, the authors utilized sterile foam dressing from negative
pressure wound therapy kit, tailored to better fill the abscess cavity and
connected with Redyrob Trans Plus?bottle. Device
changes were performed every 5 - 7 days, according to the size of the cavity
and the amount of secretions produced. The treatment was started during
hospitalization first and then continued as outpatient. Results: There was no
mortality. The amount of secretions was related to the initial size and the
degree of contamination of the abscess cavity. Antibiotic therapy was
discontinued after an average of 21 days, with a range between 14 and 32 days.
Complete healing was achieved in a median of 82 days (30 to 148) in all
patients with good functional results, no further surgery was required. Conclusions: The results of therapy
with Endosponge® seem encouraging. Success of therapy is higher if initiated as
soon possible after the intervention and is also related to the size of
dehiscence and abscess cavity. In cases with large abscesses, it is not clear
whether this new treatment leads to reduction in healing time, however, can
prevent the packaging of a (often definitive) colostomy. Further studies will
be able to select patients who will most benefit from the procedure.