Early transanal closure after vacuum‐assisted drainage for anastomotic leakage in rectal cancer surgery – a video vignette

Talboom, Kevin; Kesteren, Jurre van; Sonneveld, D J A; Tanis, Pieter J.; Bemelman, Willem A.; Hompes, Roel

doi:10.1111/codi.15032

Cited by 7 publications

(4 citation statements)

References 2 publications

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“…If a healed anastomosis was observed during endoscopy and confirmed by a CT scan with rectal contrast, the diverting ileostomy was closed. A more detailed description was published earlier and a video is available on transanal closure [ 8 , 14 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of proactive and conventional treatment of anastomotic leakage in rectal cancer surgery: a multicentre retrospective cohort series

et al. 2023

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Purpose Comparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existent. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR. Methods This retrospective cohort study included all patients with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pairwise comparison of conventional treatment and endoscopic vacuum-assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at end of follow-up. Results Overall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p < 0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compared to 78% after EVASC (p = 0.139). Functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs. 54%, p = 0.045). Early initiation of EVASC in the first week after primary surgery resulted in better functional anastomosis rate compared to later initiation (100% vs. 55%, p = 0.008). Conclusion Proactive treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.

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Section: Methodsmentioning

confidence: 99%

Comparison of proactive and conventional treatment of anastomotic leakage in rectal cancer surgery: a multicentre retrospective cohort series

et al. 2023

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“…ESC is a transanal surgical procedure, carried out under general anaesthesia, in which the anastomotic defect is closed. This can be considered when the abscess cavity is covered with granulation tissue and the rectal cuff can be reapproximated 21 , 22 , 26 . ESC is performed in the Lloyd-Davies position.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic vacuum therapy and early surgical closure after pelvic anastomotic leak: meta-analysis of bowel continuity rates

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Talboom

Roodbeen

et al. 2022

British Journal of Surgery

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Background Endoscopic vacuum therapy (EVT) with or without early surgical closure (ESC) is considered an effective option in the management of pelvic anastomotic leakage. This meta-analysis evaluated the effectiveness of EVT in terms of stoma reversal rate and the added value of ESC. Methods A systematic search of PubMed, MEDLINE, and the Cochrane Library was conducted in November 2021 to identify articles on EVT in adult patients with pelvic anastomotic leakage. The primary outcome was restored continuity rate. Following PRISMA guidelines, a meta-analysis was undertaken using a random-effects model. Results Twenty-nine studies were included, accounting for 827 patients with leakage who underwent EVT. There was large heterogeneity between studies in design and reported outcomes, and a high risk of bias. The overall weighted mean restored continuity rate was 66.8 (95 per cent c.i. 58.8 to 73.9) per cent. In patients undergoing EVT with ESC, the calculated restored continuity rate was 82 per cent (95 per cent c.i. 50.1 to 95.4) as compared to 64.7 per cent (95 per cent c.i. 55.7 to 72.7) after EVT without ESC. The mean number of sponge exchanges was 4 (95 per cent c.i. 2.7 to 4.6) and 9.8 (95 per cent c.i. 7.3 to 12.3), respectively. Sensitivity analysis showed a restored continuity rate of 81 per cent (95 per cent c.i. 55.8 to 99.5) for benign disease, 69.0 per cent (95 per cent c.i. 57.3 to 78.7) for colorectal cancer, and 65 per cent (95 per cent c.i. 48.8 to 79.1) if neoadjuvant radiotherapy was given. Conclusion EVT is associated with satisfactory stoma reversal rates that may be improved if it is combined with ESC.

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“…2. 23,25,26 Postoperative protocol entails drain removal on days 5 to 7 in the outpatient clinic and oral antibiotics for 7 to 10 days. Endoscopic inspection after 2 weeks is essential to evaluate if the procedure has been successful.…”

Section: Transanal Surgery For Acute Leaksmentioning

confidence: 99%

Dealing with Complications of Colorectal Surgery Using the Transanal Approach—When and How?

Talboom

Tanis

Bemelman

et al. 2022

Clin Colon Rectal Surg

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The transanal approach is a new and exciting addition to the surgeons' repertoire to deal with complications after colorectal surgery. Improved exposure, accessibility, and visibility greatly facilitate adequate dissection of the affected area with potential increase in effectiveness and reduced morbidity. An essential component in salvaging anastomotic leaks of low colorectal, coloanal, or ileoanal anastomoses is early diagnosis and early treatment, especially when starting with endoscopic vacuum therapy, followed by early surgical closure (endoscopic vacuum-assisted surgical closure). Redo surgery using a transanal minimally invasive surgery platform for chronic leaks after total mesorectal excision surgery or surgical causes of pouch failure successfully mitigates limited visibility and exposure by using a bottom-up approach.

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Early transanal closure after vacuum‐assisted drainage for anastomotic leakage in rectal cancer surgery – a video vignette

Cited by 7 publications

References 2 publications

Comparison of proactive and conventional treatment of anastomotic leakage in rectal cancer surgery: a multicentre retrospective cohort series

Comparison of proactive and conventional treatment of anastomotic leakage in rectal cancer surgery: a multicentre retrospective cohort series

Endoscopic vacuum therapy and early surgical closure after pelvic anastomotic leak: meta-analysis of bowel continuity rates

Dealing with Complications of Colorectal Surgery Using the Transanal Approach—When and How?

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