Endoscopic Vacuum Therapy in Colorectal Surgery

Kuehn, Florian; Janisch, Florian; Schwandner, Frank; Alsfasser, Guido; Schiffmann, Leif; Gock, Michael; Klar, E.

doi:10.1007/s11605-015-3017-7

Cited by 50 publications

(70 citation statements)

References 14 publications

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“…Kuehn et al published a further case series of 41 patients in 2016, 20 of whom suffered from a colorectal anastomotic leak [34]. Median (range) therapy duration was 23 (2–109) days with a mean (range) of 7 (2–37) sponge changes per patient.…”

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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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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“…The patient was discharged ten days later without any complications during one month follow-up (14). Endoscopic VAC therapy was approved for treatment of bowel leakage and useful also for the treatment of bowel perforation (15). Nevertheless in literature we can found just few cases of complications due to India ink tattooing.…”

Section: Discussionmentioning

confidence: 99%

“…In fact at the admission time the score was 4 and after stopping oral intake, starting TPN and intravenous antibiotic therapy, we controlled daily the clinical findings and laboratory tests to monitoring sepsis evolution. The option of endoscopic vacuum therapy was starting evaluated but because of the rapid remission of opening clinical square it was not necessary (15).…”

Section: Discussionmentioning

confidence: 99%

Complication of endoscopic tattooing: a case report of covered perforation

Falco¹,

Fontana

Tutino³

et al. 2016

Gchir

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IntroductionIn the last decade laparoscopy acquired more and more indications for many malignant and non malignant abdominal diseases although the procedure doesn't ever consent a good recognition of lesions in patients with small ones. Then tattooing is recommended (Evidence Level III and grade of recommendation A) to mark a lesion or a polypectomy site for future surgical identification (1). This procedure, that is quite cheap, should become a routine procedure in addiction to routinecolonoscopy although it isn't free from risks and complications (1). The most common technique is the India ink tattoing with saline test. This technique, according to the literature, involves the injecting 1 ml of saline solution into the submucosal layer to form a proper submucosal elevation followed by the injection of 1 to 1.5 ml of India ink (2). Patients and methodsRD, female, 63 years old. She underwent colonoscopy for diarrhoea with diagnosis of 3,5 cm polyp covered by intact mucosa, classified as lipoma of the middle tract of transverse colon. This medical case had been deeply examined with the use of Computed Tomography (CT) with ev infusion of iodate contrast medium. This examination confirmed the diagnosis of lipoma of middle transverse colon, and identified the presence of S7 hepatic angioma and inguinal lymphadenopathy (dt max 1.3 cm). Patient went in another hospital requiring a surgical approach. So the operation was planned and the Aim. Laparoscopy is considered a good approach in treatment of colorectal neoplastic diseases; the endoscopic tattooing is then recommended (Evidence Level III and grade of recommendation A) to mark a lesion or a polypectomy site for intraoperative identification. We describe the case of perforation after tattoing treated conservatively.Case

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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%

“…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%

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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Endoscopic Vacuum Therapy in Colorectal Surgery

Cited by 50 publications

References 14 publications

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

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

Complication of endoscopic tattooing: a case report of covered perforation

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

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