Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study

Borstlap, Wernard A. A.; Musters, Gijsbert D.; Stassen, Laurents P. S.; Westreenen, Henderik L. van; Hess, Daniël A.; Dieren, Susan van; Festen, Sebastiaan; Zaag, E. J. van der; Tanis, Pieter J.; Bemelman, Willem A.

doi:10.1007/s00464-017-5679-6

Cited by 80 publications

(109 citation statements)

References 28 publications

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“…reported 75% success when the treatment started within 6 weeks vs only 38% after that, which was confirmed by others as well (89% vs 50%) . This finding was also supported by the last series published in 2018 . Rates of chronic sinus of 21% vs 47% when the treatment started before and after the third week were reported .…”

Section: Discussionsupporting

confidence: 80%

“…This finding was also supported by the last series published in 2018 . Rates of chronic sinus of 21% vs 47% when the treatment started before and after the third week were reported .…”

Section: Discussionsupporting

confidence: 75%

“…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%

“…The therapy was stopped when the size of the cavity decreased to less than 10–15 mm or did not allow placement of the foam . The residual cavity was left to close spontaneously, but some authors applied fibrin glue whereas others sutured the defect . Borstlap et al .…”

Section: Resultsmentioning

confidence: 99%

“…Early implementation of therapy appears to be associated with faster recovery and a higher success rate. The aim of early treatment is to prevent the development of chronic presacral sinus (presacral abscess persisting > 12 months), which leads to failure due to fibrosis and chronic sepsis . In these cases, successful closure occurred in only 48%, which was reflected in a higher rate of permanent stoma (60%) .…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 80%

“…This finding was also supported by the last series published in 2018 . Rates of chronic sinus of 21% vs 47% when the treatment started before and after the third week were reported .…”

Section: Discussionsupporting

confidence: 75%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endoluminal negative pressure therapy in colorectal anastomotic leaks

et al. 2019

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Anastomotic Complications

Friel

Kin

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Mechanical bowel prep and oral antibiotics prior to colon resection are associated with a lower risk of anastomotic leak.• A significant proportion of anastomotic leaks present after the immediate postoperative period, especially if there is a history of pelvic radiation. • Most early anastomotic bleeds are self-limited; late bleeds may be a sign of anastomotic leak. • Anastomotic stricture after cancer resection should undergo endoscopic biopsy and imaging to rule out recurrent cancer. • Benign anastomotic strictures may be amenable to endoscopic management, but some will require surgical revision or completion proctectomy with permanent colostomy if the strictured anastomosis is in the pelvis. • Anastomotic complications often lead to significant detriments to quality of life with regard to pain, defecatory function, sexual function, and urinary function. Discussion of these issues with patients is critical for surgical decision-making. Anastomotic LeakThe unfortunate reality faced by every surgeon who performs bowel resections is the occurrence of anastomotic leaks. The incidence of anastomotic leak after bowel anastomosis ranges from 2% to 21% and is associated with significant risk of short-and long-term morbidity [1][2][3][4][5]. This complication can be a devastating event that sets off a cascade of other unfortunate events, resulting in significant det-riments to quality of life, increased pain, prolonged disability, and sometimes death. Anastomotic leaks are associated with significantly higher healthcare resource utilization and cost, as patients with this complication are more likely to require additional diagnostic tests, procedures or reoperations, hospital days, outpatient care, and readmissions [6,7]. Perhaps the most frustrating aspect of anastomotic leaks in colorectal surgery is the fact that leaks and their severe consequences still occur despite the adoption of evidence-based perioperative guidelines, efforts to optimize patient risk factors, and adherence to surgical principles. Although important progress has been made toward reducing the risk of anastomotic leak, there is still much work to be done to increase our understanding of the pathophysiology of anastomotic leak, and effective strategies for prevention.

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Behandlungsoptionen der Anastomoseninsuffizienz nach Rektumresektion

Aigner

2024

coloproctology

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Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study

Cited by 80 publications

References 28 publications

Endoluminal negative pressure therapy in colorectal anastomotic leaks

Endoluminal negative pressure therapy in colorectal anastomotic leaks

Anastomotic Complications

Behandlungsoptionen der Anastomoseninsuffizienz nach Rektumresektion

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