Endo‐sponge assisted treatment of anastomotic leakage following colorectal surgery

Abstract

Endo-sponge treatment can be recommended as an alternative approach to treat pelvic sepsis following anastomotic dehiscence or rectal stump insufficiency. Extended leakages should be treated by different approaches having little probability of successful healing, but can lead to discomfort for the patient. Radiochemotherapy does not cause a problem for application of the endo-sponge.

Anastomotic leakage after gastrointestinal surgery: Diagnosis and management

“…For patients with low colorectal or colo-anal anastomoses, dependent drainage of the abscess should be established into the digestive tract, or via a perineal route during a short anesthesia. If the fistulous tract is adequately identified, the anastomotic dehiscence can be enlarged, the walls of the abscess cureted and the cavity drained by one or two trans-anastomotic drains that exit through the anus and are left in place to allow subsequent irrigations [50]. Insertion of an Endosponge ® combined with aspirative drainage, a truly negative pressure treatment of AL, is now used more and more frequently.…”

“…A transanal pelvic drainage can be placed via the rectal stump that is left open with the advantage of radical treatment of pelvic sepsis and the AL with low operative mortality. The disadvantage is creating a difficult, more complex reconstruction procedure in a ''frozen pelvis'' with a high-risk of definitive stoma [49,50,54,55].…”

Endoluminal Negative Pressure Wound Therapy (E-NPWT) for anastomotic leakage after rectal resection

“…Riss et al 8 from Vienna, Austria, used E-NPWT for anastomotic disruption (6 patients) and rectal stump disruption (3 patients). Median time of sponge treatment was 3 weeks (2-8 weeks).…”

“…The closure rate was 75% in the early treatment group vs. 38% in the late treatment group (p = 0.315). Closure was achieved in a median of 40 (range 28-90) days with a median number of 13 sponge replacements (range [8][9][10][11][12][13][14][15][16][17].…”

“…Leakages secondary to circumscribed stable line disruption are good candidates for complete healing. Subtotal dehiscence or multiple fistulas 8 or large cavities 5 may not be closed by this technique. We have identified necrosis as another cause of failure.…”