An initial experience using transanal vacuum therapy in pelvic anastomotic leakage

Srinivasamurthy, D.; Wood, C. B.; Slater, Richard; Garner, Jeff

doi:10.1007/s10151-012-0911-9

Cited by 27 publications

(39 citation statements)

References 22 publications

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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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“…Confirmed on CT. Cavity > 3 cm, < 10 cm0%100% ( n = 5, during primary surgery)0%100%Median duration of vacuum therapy 27 daysMedian number of sponge changes = 7Mild-moderate pain scores1 stenosis requiring dilatationNerup [36]Retrospective cohortColorectal13Symptoms of a leak not requiring laparotomy. Confirmed on CT. <1month since leak diagnosed0%100% ( n = 13, at primary surgery)8% ( n = 1, end colostomy for anastomotic stenosis)92%Stoma closure rate 92%Median duration of vacuum therapy 18 daysMedian number of sponge changes = 8Riss [37]Prospective cohortColorectal23Extraperitoneal anastomosis8.70%1 fibrin glue, 1 stent73.90% ( n = 17 at primary surgery)13.10% ( n = 3, end colostomy)86.90%Median time for healing 21 daysMedian follow-up 17 monthsRecurrent abscess 21.7%Srinivasamurthy [38]Retrospective case seriesColorectal8Extraperitoneal low anastomosisDiagnosed on CT or contrast enema0%100% ( n = 8, at primary surgery)25% ( n = 1, APR for persistent perianal sepsis, n = 1, end colostomy for intra-peritoneal sponge placement)75%Stoma closure rate 62.5% with ‘good or reasonable function’Strangio [39]Prospective case seriesColorectal n = 1925Symptoms and signs of leak, confirmed on CT0%52% ( n = 13, at primary surgery)12% (1 patient for ureteric stent, 1 patient small bowel resection for fistula, 1 abscess drainage and disruption of anastomosis)88%Stoma closure rate 84.6%Colonic n = 5Ileo-rectal n = 1vBernstorff [40]Prospective case seriesColorectal26Extraperitoneal anastomosis, not requiring surgical intervention…”

Section: Resultsmentioning

confidence: 99%

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

et al. 2019

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BackgroundAnastomotic complications following colorectal surgery are associated with significant morbidity and mortality. For patients in whom systemic sepsis is absent or well controlled, minimal access techniques, such as endoscopic therapies, are being increasingly employed to reduce the morbidity of surgical re-intervention. In this review, we aim to assess the utility of endoscopic management in the acute setting of colorectal anastomotic complications, focusing on anastomotic leak.MethodA literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases using the search criteria string “colorectal anastomotic (“leak” OR “bleed”), “endoscopy”, endoscopic management”. Additional papers were detected by scanning the references of relevant papers. Data were extracted from each study by two authors onto a dedicated pro-forma. Given the nature of the data extracted, no meta-analysis was performed.ResultsA total of 89 papers were identified, 16 of which were included in this review; an additional 14 papers were obtained from reference searches. In patients who are not physiologically compromised, there are promising data regarding the salvage rate of stents, over-the-scope endoscopic clips, vacuum therapy and fibrin glue in the early management of colorectal anastomotic leak. There is no consensus regarding the optimal approach, and data to assist the physician in patient selection are lacking. Whilst data on salvage (i.e. healing and avoidance of surgery) are well understood, no data on functional outcomes are reported.ConclusionEndoscopic therapy in the management of stable patients with colorectal anastomotic leaks appears safe and in selected patients is associated with high rates of technical success. Challenges remain in selecting the most appropriate strategy, patient selection, and understanding the functional and long-term sequelae of this approach. Further evidence from large prospective cohort studies are needed to further evaluate the role of these novel strategies.

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“…Nine studies stated their length of follow‐up (Table ). Five papers reported functional outcomes and three reported quality of life outcomes (Tables and ). Mennigen et al .…”

Section: Resultsmentioning

confidence: 99%

Management of early pouch‐related septic complications in ulcerative colitis: a systematic review

et al. 2018

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An initial experience using transanal vacuum therapy in pelvic anastomotic leakage

Abstract: Early use of Endosponge™ therapy appears to offer a minimally invasive and effective way of closing the presacral cavity after a pelvic anastomotic leak, reducing the risk of permanent stoma and resulting in acceptable bowel function. Endosponge™-specific complications can occur.

Cited by 27 publications

References 22 publications

Endoluminal negative pressure therapy in colorectal anastomotic leaks

Endoluminal negative pressure therapy in colorectal anastomotic leaks

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

Management of early pouch‐related septic complications in ulcerative colitis: a systematic review

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