Endoscopic Solutions for Colorectal Anastomotic Leaks

Advances in Hydrogel Adhesives for Gastrointestinal Wound Closure and Repair

“…One of the deadliest complications of anastomosis is anastomotic leakage (AL), the leak of luminal contents into the abdominal cavity. The overall incidence rate varies from 6% to 20% with complications such as sepsis, peritonitis, or multiple organ failure resulting in a mortality rate between 13% and 27% [ 18 , 71 , 72 ]. AL etiology is multifactorial, mostly based on ischemia of the bowel endings and/or technical failure [ 73 ].…”

“…The severity of the leak and the clinical condition of the patient govern the management of AL, ranging from nonoperative to operative interventions [ 75 ]. Nonoperative managements include parenteral nutrition, broad-spectrum antibiotics, and radiological drainage [ 72 ]. Traditional operative intervention for AL is the resection of the anastomosis with exteriorization of the proximal limb as an end colostomy, also known as the Hartmann’s procedure [ 75 ].…”

“…Recently, laparoscopic anastomotic surgery is gaining attention as an alternative to open surgery due to the many advantages of minimally invasive surgery [ 71 ]. Endoscopic techniques are relatively new conservative options that reduce the necessity for a stoma or can be performed as supplementary-to-surgery treatments to enhance the healing process [ 72 ]. The most commonly applied endoscopic solutions are endoscopic clipping, suturing, stenting, and vacuum-assisted endosponge therapy [ 72 , 75 ].…”

“…Endoscopic techniques are relatively new conservative options that reduce the necessity for a stoma or can be performed as supplementary-to-surgery treatments to enhance the healing process [ 72 ]. The most commonly applied endoscopic solutions are endoscopic clipping, suturing, stenting, and vacuum-assisted endosponge therapy [ 72 , 75 ]. Despite their high success rate (about 80–90%), they are limited to small leaks, require additional anchoring reinforcements, and can cause bleeding, perforation, and adjacent injuries [ 72 ].…”

“…The most commonly applied endoscopic solutions are endoscopic clipping, suturing, stenting, and vacuum-assisted endosponge therapy [ 72 , 75 ]. Despite their high success rate (about 80–90%), they are limited to small leaks, require additional anchoring reinforcements, and can cause bleeding, perforation, and adjacent injuries [ 72 ]. In clinical research, fibrin glue, cyanoacrylate, PEG-based hydrogel, and other commercially available adhesives have been used to reinforce the stapling and suturing lines to seal GI anastomosis [ 73 ].…”