Endo-sponge therapy for management of anastomotic leakages after colorectal surgery: A case series and review of literature

Strangio, G.; Zullo, Angelo; Ferrara, E.C.; Anderloni, Andrea; Carlino, A.; Jovani, Manol; Ciscato, Camilla; Hassan, Cesare; Repici, Alessandro

doi:10.1016/j.dld.2015.02.007

Cited by 54 publications

(64 citation statements)

References 32 publications

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“…Confirmed on CT. Cavity > 3 cm, < 10 cm0%100% ( n = 5, during primary surgery)0%100%Median duration of vacuum therapy 27 daysMedian number of sponge changes = 7Mild-moderate pain scores1 stenosis requiring dilatationNerup [36]Retrospective cohortColorectal13Symptoms of a leak not requiring laparotomy. Confirmed on CT. <1month since leak diagnosed0%100% ( n = 13, at primary surgery)8% ( n = 1, end colostomy for anastomotic stenosis)92%Stoma closure rate 92%Median duration of vacuum therapy 18 daysMedian number of sponge changes = 8Riss [37]Prospective cohortColorectal23Extraperitoneal anastomosis8.70%1 fibrin glue, 1 stent73.90% ( n = 17 at primary surgery)13.10% ( n = 3, end colostomy)86.90%Median time for healing 21 daysMedian follow-up 17 monthsRecurrent abscess 21.7%Srinivasamurthy [38]Retrospective case seriesColorectal8Extraperitoneal low anastomosisDiagnosed on CT or contrast enema0%100% ( n = 8, at primary surgery)25% ( n = 1, APR for persistent perianal sepsis, n = 1, end colostomy for intra-peritoneal sponge placement)75%Stoma closure rate 62.5% with ‘good or reasonable function’Strangio [39]Prospective case seriesColorectal n = 1925Symptoms and signs of leak, confirmed on CT0%52% ( n = 13, at primary surgery)12% (1 patient for ureteric stent, 1 patient small bowel resection for fistula, 1 abscess drainage and disruption of anastomosis)88%Stoma closure rate 84.6%Colonic n = 5Ileo-rectal n = 1vBernstorff [40]Prospective case seriesColorectal26Extraperitoneal anastomosis, not requiring surgical intervention…”

Section: Resultsmentioning

confidence: 99%

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Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

et al. 2019

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BackgroundAnastomotic complications following colorectal surgery are associated with significant morbidity and mortality. For patients in whom systemic sepsis is absent or well controlled, minimal access techniques, such as endoscopic therapies, are being increasingly employed to reduce the morbidity of surgical re-intervention. In this review, we aim to assess the utility of endoscopic management in the acute setting of colorectal anastomotic complications, focusing on anastomotic leak.MethodA literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases using the search criteria string “colorectal anastomotic (“leak” OR “bleed”), “endoscopy”, endoscopic management”. Additional papers were detected by scanning the references of relevant papers. Data were extracted from each study by two authors onto a dedicated pro-forma. Given the nature of the data extracted, no meta-analysis was performed.ResultsA total of 89 papers were identified, 16 of which were included in this review; an additional 14 papers were obtained from reference searches. In patients who are not physiologically compromised, there are promising data regarding the salvage rate of stents, over-the-scope endoscopic clips, vacuum therapy and fibrin glue in the early management of colorectal anastomotic leak. There is no consensus regarding the optimal approach, and data to assist the physician in patient selection are lacking. Whilst data on salvage (i.e. healing and avoidance of surgery) are well understood, no data on functional outcomes are reported.ConclusionEndoscopic therapy in the management of stable patients with colorectal anastomotic leaks appears safe and in selected patients is associated with high rates of technical success. Challenges remain in selecting the most appropriate strategy, patient selection, and understanding the functional and long-term sequelae of this approach. Further evidence from large prospective cohort studies are needed to further evaluate the role of these novel strategies.

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Section: Resultsmentioning

confidence: 99%

“…The anastomotic salvage rate was 90%, with only two patients requiring return to theatre for exteriorisation of a necrotic anastomosis. Similarly, Strangio et al published a single centre series in Milan in 2015 [39]. Of 296 patients undergoing colorectal surgery, 40 (13.4%) patients developed an anastomotic leak.…”

Section: Resultsmentioning

confidence: 99%

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

et al. 2019

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“…Despite advances in surgical techniques, the incidence of AL remains high, even in experienced hands (1%‐21%) . Contributing factors for this situation are tumor size, its localization, the tumor stage, the neoadjuvant chemo‐ and radiotherapy to which the patient has been subjected prior surgical excision and the absence of a protective ileostomy …”

Section: Introductionmentioning

confidence: 99%

Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: A systematic review

Chorti

Stavrou

Stelmach

et al. 2019

Asian J Endoscop Surgery

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Introduction Anastomotic leakage (AL) after low anterior resection for rectal cancer is a severe complication. Except for re‐operation, several endoscopic options have been proposed for the minimal invasive treatment of AL, including the endoluminal vacuum devices, tissue sealants and Over‐The‐Scope‐Clip (OTSC) technique. The aim of the present review is to evaluate the effect of alternative treatment options for AL repair, by means of endoscopy. Method A bibliographic search was performed in the international literature. Ten case reports and series were finally included, reporting 75 cases of endoscopic repair of AL. A descriptive statistical analysis and a systematic review were performed. Results The patients' mean age was 65.84 ± 9.92 years (95% CI: 61.70‐68.76), the male‐to‐female ratio being 1.5:1. The mean diameter of the cavity was 5.17 ± 3.32 cm (95% CI: 4.03‐6.31). The mean time until the diagnosis was 44.15 ± 105.91 days (95% CI: 13.39‐74.90). Vacuum‐assisted closure therapy was the most common technique (52%), followed by fibrin glue (25.3%) and OTSC (22.7%). As supplementary therapy, OTSC was applied in 8.3%, vacuum‐assisted closure in 25%, endoclips in 4.2%, while fibrin glue was the most frequently used (62.5%). Conclusion Endoscopic management of AL after low anterior resection is considered as an alternative to surgical treatment with promising results.

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“…Candida albicans (a common commensal organism) is the most common cause of endogenous fungal endophthalmitis. Endoluminal vacuum therapy is increasingly being used to manage anastomotic leakage following colorectal surgery 1. Endo-sponges (B Braun Medical Ltd) are a type of endoluminal vacuum therapy, where a sponge sits within the cavity and mild negative pressure allows continuous drainage.…”

Section: Introductionmentioning

confidence: 99%

Fungal endophthalmitis: an unusual complication of GI surgery and endoluminal vacuum therapy

2015

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SUMMARYWe present a case of endogenous fungal endophthalmitis arising as a complication of fungal septicaemia following gastrointestinal surgery, and subsequent treatment with endoluminal vacuum therapy (Endo-SPONGE, B Braun Medical Ltd). Our patient developed a pre-sacral collection due to an anastomotic leak post ileoanal pouch formation. Despite treatment with Endo-sponges and antibiotics, the patient suffered recurrent sepsis and the cavity failed to reduce in size. He developed red eyes and blurred vision, leading to the diagnosis of fungal endophthalmitis. Extended fungal cultures of the Endo-sponges and pouch effluent revealed Candida spp. This case is the first report of fungal endophthalmitis associated with Endo-sponge use and highlights the importance of fungal cultures in patients with ongoing sepsis. BACKGROUND

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Endo-sponge therapy for management of anastomotic leakages after colorectal surgery: A case series and review of literature

Cited by 54 publications

References 32 publications

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: A systematic review

Fungal endophthalmitis: an unusual complication of GI surgery and endoluminal vacuum therapy

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