Delayed Endoluminal Vacuum Therapy for Rectal Anastomotic Leaks after Rectal Resection in a Swine Model: A New Treatment Option

Abstract

Anastomotic leaks are a dreaded surgical complication following colorectal operations. Creation of a temporary proximal diverting ileostomy is used in high-risk anastomoses, however, additional surgical risk is accumulated with its creation and reversal. Endoluminal vacuum therapy has been shown to seal anastomotic defects in the prophylactic setting in a pig model and we hypothesized it could be utilized in a delayed fashion to rescue subjects with an active anastomotic leak. Yorkshire pigs underwent rectal resection, intentional leak confirmed by fluoroscopy, and endoluminal vacuum therapy device placement to low continuous suction. Following treatment, a contrast enema and necropsy was performed for gross and histopathology. Pigs underwent 2 (or 5) days of free intraperitoneal leak prior to device placement and 5 (or 7) subsequent days of endoluminal vacuum therapy. Six of seven early-treated pigs sealed their anastomotic defect, while two of the four treated pigs in this extended group sealed the defect. Endoluminal vacuum therapy is feasible and well tolerated in a pig model, and it has been shown to seal a significant number of freely leaking anastomoses in the early period (86%). This technology warrants further study as it may provide a noninvasive means to treatment of anastomotic leaks. Clin Trans Sci 2014; Volume 7: 121-126

Endoluminal Vacuum Therapy for Ivor Lewis Anastomotic Leaks: A Pilot Study in a Swine Model

“…The endoluminal vacuum device was created using black Granu‐Foam (Kinetic Concept, San Antonio, TX) arranged around two 16‐French nasogastric tubes (Bard Medical, Covington, GA). The distal tube was placed within the Granu‐Foam to provide negative pressure to the sponge while the proximal tubing terminated in the proximal esophagus to suction secretions ( Figure ) …”

“…All pig characteristics, operative preparation anesthesia, and postoperative care has been previously described and published . Ten female Yorkshire pigs were utilized in this study.…”

“…Prior to the beginning of the operation, the pigs were assigned to either the control or the experimental group. Anesthesia was conducted as previously described . Throughout the operation, the pigs were monitored continuously with cardiopulmonary monitors and warmed with both a warm water‐circulating bath and warm lactated Ringer's solution.…”

“…On postoperative day 5, unless otherwise specified in the results, pigs were euthanized with Euthasol (Vibac), as previously described . The EVD was removed at the end of the study and a postmortem upper gastrointestinal study with contrast (50% Hypaque diluted with water) was performed.…”

“…In this study, we investigate the feasibility of using an endoluminal negative pressure vacuum device to heal intentional anastomotic leaks in the thoracic esophageal conduit following an Ivor Lewis esophagectomy in a swine model. We have previously utilized this device in a swine low anterior resection model in both a prophylactic and salvage fashion, in which the anastomotic defects fully healed using the device . We hypothesized that we would have comparable results using this device in an Ivor Lewis esophagectomy model to seal anastomotic leaks.…”