A New Perspective on Vacuum-Assisted Closure for the Treatment of Anastomotic Leak Following Low Anterior Resection for Rectal Cancer, Is It Worthy?

Jiménez-Rodríguez, Rosa M; Araujo-Míguez, Ángela; Sobrino-Rodríguez, Salvador; Heller, F.; Díaz-Pavón, José Manuel; García, Juan Manuel Bozada; Portilla, Fernando de la

doi:10.1177/1553350618771410

Cited by 18 publications

(34 citation statements)

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“…A total of 114 publications were found. Thirty of them, published between 2006 and 2018, were considered relevant . Four were excluded because they reported overlapping cases and only the most recent series were included .…”

Section: Resultsmentioning

confidence: 99%

Endoluminal negative pressure therapy in colorectal anastomotic leaks

et al. 2019

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Aim The aim of the present work was to perform an up‐to‐date review of the literature on endoluminal negative pressure therapy for colorectal anastomotic leak. Method An electronic search in PubMed and Google Scholar and a manual search without language restrictions were performed on 25 January 2019. Only original series reporting endoluminal negative pressure therapy in colorectal anastomotic leaks were included. The primary outcome was the success rate (complete closure of the abscess cavity). The secondary outcomes were the rates of complications and stoma closure. Results Nineteen series with a total of 295 cases were analysed. The median distance of the anastomosis from the anal verge and the size of the abscess were 5.65 cm (4.9–10) and 6.0 cm (5–8.1) respectively. In 84.5% (78%–91%) the stoma was created at the first intervention. Neoadjuvant therapy was performed in 48.6% (3%–60%). Median 7 sponges (2–34) were used with median negative pressure 150 mmHg (125–700) for a median of 31 days (14–127). The success rate was 85.4% (80%–91%) with ileostomy closure in 72.6%. Complications were observed in 19% (13%–25%): abscesses 11.5% and anastomotic stenosis 4.4%. Laparotomy was required in 15% of the complications. The stoma was the only significant predictor for the success of the therapy (0.007, SE 0.004, P = 0.040). Conclusions The initial experience looks promising with an 85% success rate, which precludes risky re‐resections with redo anastomosis or Hartmann's procedure. Despite the good initial results, definitive conclusions cannot be drawn because of the small sample size and the lack of high‐quality comparative studies.

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Section: Resultsmentioning

confidence: 99%

Endoluminal negative pressure therapy in colorectal anastomotic leaks

et al. 2019

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“…Shortened healing time (median: 51 days) is proposed in the VAC group vs control group . According to different studies, the overall success rate of VAC therapy ranges from 79% to 94%, while the median heal time ranges from 20 to 244 days . Additional therapy with fibrin glue was applied to 13 out of 15 patients in Glitsch et al’s study .…”

Section: Discussionmentioning

confidence: 99%

“…Additional therapy with fibrin glue was applied to 13 out of 15 patients in Glitsch et al’s study . Three studies separated their participants into two groups according to the onset of treatment; the group of early term therapy had a better healing rate compared to the late term group . Strangio et al reported the data of the seven larger studies for VAC therapy of AL, which resulted in 94.3% healing rate of presacral abscess cavities …”

Section: Discussionmentioning

confidence: 99%

“…Eligible for analysis were 24 publications that referred to anastomotic leak after low anterior resection for rectal cancer and reported detailed information about patients' characteristics. Eight articles out of 24 were clinical studies, five were reviews, one systematic review and 10 were case reports and series, including 75 cases of endoscopic repair of anastomotic leak (Table ). These articles were carefully analyzed and a database with the patients' characteristics was made.…”

Section: Methodsmentioning

confidence: 99%

“…Anastomotic leakage (AL) after low anterior resection for rectal cancer is a severe complication with increased morbidity and mortality rates up to 22% . Despite advances in surgical techniques, the incidence of AL remains high, even in experienced hands (1%‐21%) .…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: A systematic review

Chorti

Stavrou

Stelmach

et al. 2019

Asian J Endoscop Surgery

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Introduction Anastomotic leakage (AL) after low anterior resection for rectal cancer is a severe complication. Except for re‐operation, several endoscopic options have been proposed for the minimal invasive treatment of AL, including the endoluminal vacuum devices, tissue sealants and Over‐The‐Scope‐Clip (OTSC) technique. The aim of the present review is to evaluate the effect of alternative treatment options for AL repair, by means of endoscopy. Method A bibliographic search was performed in the international literature. Ten case reports and series were finally included, reporting 75 cases of endoscopic repair of AL. A descriptive statistical analysis and a systematic review were performed. Results The patients' mean age was 65.84 ± 9.92 years (95% CI: 61.70‐68.76), the male‐to‐female ratio being 1.5:1. The mean diameter of the cavity was 5.17 ± 3.32 cm (95% CI: 4.03‐6.31). The mean time until the diagnosis was 44.15 ± 105.91 days (95% CI: 13.39‐74.90). Vacuum‐assisted closure therapy was the most common technique (52%), followed by fibrin glue (25.3%) and OTSC (22.7%). As supplementary therapy, OTSC was applied in 8.3%, vacuum‐assisted closure in 25%, endoclips in 4.2%, while fibrin glue was the most frequently used (62.5%). Conclusion Endoscopic management of AL after low anterior resection is considered as an alternative to surgical treatment with promising results.

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