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. 2022 Feb;36(2):959-967.
doi: 10.1007/s00464-021-08359-4. Epub 2021 Mar 1.

Transrectal endoscopic drainage with vacuum-assisted therapy in patients with anastomotic leaks following rectal cancer resection

Mateusz Jagielski  1 , Jacek Piątkowski  2 , Grzegorz Jarczyk  2 , Marek Jackowski  2
Affiliations

Transrectal endoscopic drainage with vacuum-assisted therapy in patients with anastomotic leaks following rectal cancer resection

Mateusz Jagielski et al. Surg Endosc. 2022 Feb.

Abstract

Background: Surgery is the gold standard for the treatment of malignant tumors of the rectum. Intestinal anastomotic leakage remains a serious complication of colorectal surgery. The efficacy and safety of transrectal endoscopic drainage by vacuum therapy in patients with intestinal anastomotic leakage after surgical treatment of middle and distal rectal tumors were assessed.

Methods: Prospective analysis of treatment outcomes among patients undergoing surgery for middle and distal rectal tumors at the Department of General, Gastroenterological, and Oncological Surgery of the Ludwik Rydygier Collegium Medicum in Bydgoszcz and Nicolaus Copernicus University in Torun from 2016 to 2019 was conducted.

Results: Seventy-nine patients with middle and distal rectal tumors underwent laparoscopic resection. Intestinal anastomotic leak was identified in 18 (22.79%) patients [all men, mean age 61.39 (43-86) years] during the postoperative period. Primary protective ileostomy was performed in 8/18 (44.44%) patients. All 18 patients were treated with endoluminal vacuum therapy via transrectal endoscopic drainage. The mean time from surgery to the diagnosis of leakage and initiation of endoscopic treatment was 16 (3-728) days. The mean number of endoscopic procedures per patient was 6 (1-11). The mean duration of endoscopic treatment was 22 (4-43) days. Complications of endotherapy occurred in 2/18 (11.11%) patients treated endoscopically for bleeding from the abscess cavity. Success of endoluminal vacuum therapy was achieved in 17/18 (94.44%) patients. Moreover, 5/18 (27.78%) patients required ileostomy during the endoscopic treatment. The mean follow-up period was 368 (118-724) days. Long-term success of transrectal endoscopic drainage using vacuum-assisted therapy was achieved in 15/18 (83.33%) patients.

Conclusions: Endoscopic rectal drainage using vacuum-assisted therapy is an effective and safe minimally invasive treatment in patients with intestinal anastomotic leaks following resection procedures within the middle and distal rectum.

Keywords: Anastomotic leak; Ileostomy; Rectal tumors; Vacuum-assisted therapy.

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Conflict of interest statement

Mateusz Jagielski, Jacek Piątkowski, Grzegorz Jarczyk, and Marek Jackowski have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
A–C The anastomotic leak did not exceed 30 mm on endoscopic examination (A, B). An 8-Fr drainage catheter was introduced transrectally under endoscopic and fluoroscopic guidance through the site of the leak (C)
Fig. 2
Fig. 2
A–D Intra-abdominal vacuum-assisted therapy using the transrectal endo-SPONGE drainage system. Patient on Day 3 after TaTME. Initially, a small intestinal anastomotic leak noted in endoscopy (A) drainage catheter was introduced transrectally into the abscess cavity through the site of the leakage under endoscopic and fluoroscopic control. Progression of anastomotic dehiscence was found after 7 days of drainage during the following endoscopic procedure (B). The patient underwent transrectal vacuum therapy (C), which continued for 20 days. A follow-up endoscopic study performed at 3 months demonstrated closure of the leakage with granulomatous tissue (D)
Fig. 3
Fig. 3
A–C The commercially available endoluminal vacuum system (Endosponge®, B Braun, Melsungen, Germany) for treatment of patients with anastomotic leaks
Fig. 4
Fig. 4
The consort flowchart of patients selection
See this image and copyright information in PMC

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