Endo-sponge Assisted Early Surgical Closure of Ileal Pouch-anal Anastomotic Leakage Preserves Long-term Function: A Cohort Study

Abstract

Background and Aims Endo-sponge [Braun Medical] assisted early surgical closure [ESC] is an effective treatment to control pelvic sepsis after ileal pouch-anal anastomosis [IPAA] leakage, and became standard treatment in our centre from 2010 onwards. The aim of this cohort study was to assess the long-term pouch function of ulcerative colitis [UC] patients treated with ESC or conventional management [CM] for anastomotic leakage after IPAA. Methods Consecutive patients who underwent an IPAA for UC between 2002 and 2017 were included. Patients treated with ESC [2010–2017] or CM [2002–2009] for anastomotic leakage were compared with control patients without anastomotic leakage of the corresponding time period. Main endpoints were long-term pouch function on a 3-point scale and pouch failure, as measured with the validated pouch dysfunction score questionnaire. Results Some 280 of 334 patients [84%] returned the pouch dysfunction questionnaire, of whom 18 were treated with ESC and 22 with CM for anastomotic leakage. Control cohorts included 133 [2010–2017] and 107 patients [2002–2009]. Between ESC-treated patients and control patients, pouch function [p = 0.647] and pouch failure rates [0/18 versus 5/133, p >0.99] were similar. CM resulted in worse pouch function [p = 0.016] and a higher pouch failure rate [5/22 versus 5/107, p = 0.013] compared with control patients. Conclusions ESC, in contrast to CM, for IPAA leakage in UC patients is associated with preservation of pouch function and preclusion of pouch failure, probably due to early and effective treatment of pelvic sepsis.

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.…”

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis

“…Single-center studies using transanal vacuum-assisted closure therapy showed good short-term outcomes in terms of complete healing and ileostomy closure rate [150,151]. A recent report demonstrated that this treatment was associated with improved pouch function and a lower incidence of pouch failure compared to conventional management [152].…”

Successful Closure of the Tip of the “J” Fistula of the Ileal Pouch With Double Over-the-Scope Clips

“… 7 , 9 A simple leak at the tip of the “J” has been treated with OTSC as demonstrated in a previous case series 7 and case reports. 12 , 13 Although endosponge or endoluminal vacuum-assisted therapy has been used for the treatment of acute anastomotic leaks after IPAA, 14 , 15 its role in the management of chronic leaks or fistulas has not been established.…”