Early reconstruction of the leaking ileal pouch‐anal anastomosis: a novel solution to an old problem

Gardenbroek, Tjibbe J.; Musters, Gijsbert D.; Buskens, C; Ponsioen, Cyriel Y.; DʼHaens, G; Dijkgraaf, M.G.W.; Tanis, Pieter J.; Bemelman, Willem A.

doi:10.1111/codi.12867

Cited by 55 publications

(71 citation statements)

References 13 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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“…Kirat et al. 's series only described leaks from the ‘tip’ (blind end) of the J pouch, whereas the cumulative 22 patients from the Dutch trials only dealt with low leaks, i.e. at the IAA or just above.…”

Section: Resultsmentioning

confidence: 99%

“…'s 27 patients with leak from the blind end of the pouch were primarily defunctioned , compared with 4 of 15 in Gardenbroek et al. 's series of anastomotic leaks . Not all patients without a primary ileostomy were subsequently defunctioned: Raval et al .…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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“…Pelvic abscesses seem to be common either due to anastomotic insufficiency or due to recurrence of the abscess at the former site of the presacral sinus. Endosponge-assisted drainage and salvage of the anastomosis seems useful [14]. It is important to highlight a common problem experienced during many of the TAMIS procedures related to the access channel (GelPOINT ® Path Transanal Access Platform).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of the TAMIS technique for redo pelvic surgery

et al. 2016

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AimThe aim of this study was to report on the feasibility of transanal minimally invasive surgery (TAMIS) as a novel approach to redo colorectal or ileoanal anastomoses.MethodsFrom October 2014, a prospective institutional database was created for all consecutive patients who underwent redo surgery by TAMIS for presacral sinus or anastomotic stenosis after low anterior resection or pouch-related problems following restorative proctocolectomy. Intra-operative feasibility, 30-day postoperative outcomes, intestinal continuity and complications after 6-month follow-up were evaluated.ResultsOf 17 included patients, 14 underwent anastomotic reconstruction and three completion proctectomy. The median operation time was 265 min (range 201–413). A successful rendezvous with simultaneous transabdominal access was achieved in 15 patients, and the procedure was completed by TAMIS alone in two. Five patients were readmitted within 30 days (29 %). Two (14 %) patients developed an anastomotic leakage within 30 days and 4 (24 %) developed a pelvic abscess requiring reintervention. One patient developed an urethra stenosis and was managed with a suprapubic catheter. Median follow-up was 9 (6–15) months. Within 6-month follow-up, the redo-TAMIS 1 patient developed a delayed anastomotic leak and 1 patient had a recurrent presacral abscess after stoma closure. Intestinal continuity was reached in 71 % of the patients at 6-month follow-up.ConclusionTAMIS is a valuable approach in redo pelvic surgery, but is still associated with high complication rates related to the complexity of the underlying problem.

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Early reconstruction of the leaking ileal pouch‐anal anastomosis: a novel solution to an old problem

Abstract: Early surgical closure after a short period of Endo-sponge® treatment is highly effective in treating anastomotic leakage after IPAA without increasing cost.

Cited by 55 publications

References 13 publications

Endoluminal negative pressure therapy in colorectal anastomotic leaks

Endoluminal negative pressure therapy in colorectal anastomotic leaks

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

Feasibility of the TAMIS technique for redo pelvic surgery

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