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Surg Endosc (2008) 22:18181825 DOI 10.1007/s00464-007-9706-x
Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method
Rolf Weidenhagen Klaus Uwe Gruetzner Timm Wiecken Fritz Spelsberg Karl-Walter Jauch
Received: 10 May 2007 / Accepted: 22 August 2007 / Published online: 20 December 2007 Springer Science+Business Media, LLC 2007
Abstract Background Conservative treatment of anastomotic leakage after anterior resection of the rectum seems to be possible in patients who have no occurrence of generalized peritonitis. This report describes a new method of endoscopic management of large anastomotic leakage in these patients.Method The main feature of this new method is the endoscopically assisted placement of an open-cell sponge connected to a vacuum device into the abscess cavity via an introducer device. The sponge system is changed every 4872 h.Results Twenty-nine patients with an anastomotic leakage after anterior resection were treated with the endoscopic vacuum therapy. The total duration of endovac therapy was 34.4 19.4 days. The total number of endoscopic sessions per patient was 11.4 6.3. In 21 of the 29 patients, a protecting stoma was created at the primary operation. Four patients were treated successfully without the need of a secondary stoma. Denitive healing was achieved in 28 of the 29 patients.Conclusions Endoscopic vacuum-assisted closure is a new efcacious modality for treating anastomotic leakage following anterior resection due to an effective control of
the septic focus. Further studies will show if it is possible to reduce the high mortality rate of patients with anastomotic leakage through the avoidance of surgical reinterventions while at the same time preserving the sphincter function.
Keywords Endoscopic Closure Anastomotic
Leakage Resection Rectum
Anastomotic leakage is the most signicant complication after anterior resection of the rectum and is the major cause of postoperative mortality and morbidity [15]. The reported incidence of symptomatic leakage is between1.5% and 17.5% [1, 2, 69] and is associated with a mortality rate between 6% and 22% [10]. Despite improvements in surgical techniques and surgical devices, colorectal anastomoses are still prone to leakage [11, 12]. Although signicant progress has been made in understanding the perioperative factors that predispose to anastomotic leakage [3, 4, 6, 13, 14], little is known about the best treatment for this problem [1520]. Available treatments range from conservative treatments...