Endoluminal vacuum-assisted therapy as treatment for anastomotic leak after ileal pouch–anal anastomosis: a pilot study

Abstract

Endosponge is effective as the only treatment after IPAA leak. Based on the results of our prospective pilot study, application of Endosponge should be the treatment of choice in selected pouch anastomotic leaks not requiring immediate surgery. These results will have to be confirmed by future prospective studies including a larger number of patients.

Increasing experience of modified two‐stage transanal ileal pouch–anal anastomosis for therapy refractory ulcerative colitis. What have we learned? A retrospective analysis on 75 consecutive cases at a tertiary referral hospital

“…Ileostomy-specific morbidity such as anastomotic leak, dehydration and renal failure are also well reported [29]. This study also confirms that active rescue of a failed anastomosis (endoscopic vacuum-assisted closure of the anastomotic defect) ensures IPAA healing and early stoma reversal [30,31]. For all these reasons, we do not create a diverting ileostomy unless technical difficulties are encountered during IPAA construction.…”

Evidence of negative pressure therapy for anastomotic leak: a systematic review

“…Success rates within the studies sample ranged from 60% to 100%. Four studies reported 100% 17–20 . Fifty‐eight percent of the studies had >84% success rate 17–25 .…”

“…Four studies reported 100% 17–20 . Fifty‐eight percent of the studies had >84% success rate 17–25 . The four studies that reported 100% success each had varying definitions which included; ‘no sign of leakage of contrast during a contrast enema or abdominal CT scan with intravenous, oral and rectal contrast and an intact anastomosis during endoscopic inspection’, 17 ‘A complete leakage closure was verified at endoscopic and/or radiological assessment’.…”

“…The four studies that reported 100% success each had varying definitions which included; ‘no sign of leakage of contrast during a contrast enema or abdominal CT scan with intravenous, oral and rectal contrast and an intact anastomosis during endoscopic inspection’, 17 ‘A complete leakage closure was verified at endoscopic and/or radiological assessment’. ‘…until fistula closure was achieved…’, 18 ‘We ceased treatment when the cavity was about 3 cm wide and covered with granulation tissue’, 19 ‘Healing was defined as the closure of the defect after a progressive reduction in size of the cavity without signs of infection or complications, not requiring any intervention than the follow‐up pouchoscopy’ 20 . Interestingly, follow‐up in these four studies was not reported for two, 18,19 one followed up patients at 1 month 20 and one had a median follow‐up of 25 months 17 …”

Treatment strategy and outcome of anastomotic leakage after left-sided colorectal cancer surgery –Non-surgical V.S. Surgical treatment–

“…Recently, reports of endoluminal negative pressure treatment have frequently used. It is the method that can treat the AL with minimal invasion by using sponge trans-anal in abscess and apply continuous negative pres-sure to close the abscess cavity [4][5][6][7][8] . However, according to a review by G.I.Popivanov et al, there were 84.5% patients who needed to create stoma, and 72.6% patients underwent stoma closure.…”