Introduction of a handmade vacuum-assisted sponge drain for the treatment of anastomotic leakage after low anterior rectal resection

Abstract

Purpose: Anastomotic leakage, a known major postoperative complication, potentially leads to readmission, reoperation, and increased mortality rates in patients, such as rectal cancer patients following a low anterior resection (LAR). Currently, vacuum-assisted closure, as featured by B-Braun (B-Braun Medical B.V.), is already being used for the treatment of gastrointestinal leakages and fistulas. The main aim of this study was to introduce a novel method for creating a vacuum-assisted drain for the treatment of anastomotic leakage after LAR.

Methods: All 10 patients, who underwent LAR surgery from 2018 to 2019, were diagnosed with anastomotic leakage and had received neoadjuvant chemotherapy prior to surgery. Therefore, patients were treated with a handmade vacuum-assisted drain and were revisited every 5 to 7 days for further evaluations and drain replacement until leakage resolution. Physical features of cavity, time of diagnose, and duration of treatment were analyzed correspondingly. The handmade vacuum-assisted sponge drain was prepared for each patient in each session of follow-up.

Results: Eight out of 10 patients experienced complete closure of the defect. The mean delay time from the day of operation to the diagnosis of anastomotic leakage was 61.0±80.4 days while the mean time for leakage closure was 117.6±68.3 days. Eventually, 7 cases underwent ileostomy reversal with no complications during a 3-month follow-up.

Conclusion: In this study, we evaluated the healing process of anastomotic leakage after the usage of a handmade vacuum-assisted sponge drain in a case series method. In our trial, we provided an innovative cost-benefit method easily applicable in the operating room.

Keywords: Anastomotic leak; Drainage; Negative-pressure wound therapy; Rectal neoplasms; Vacuum.

Fig. 1.

Design and fabricate a handmade vacuum-assisted closure (VAC) for rectal anastomosis. Briefly, the sponge is trimmed to the size of the cavity (a, b) and is rolled around the drain tip while completely covers the drain (c), and is sutured to the sponge, including both parts to prevent drain removal (d). In lithotomy position, the VAC is placed in the anastomosis leakage site using a ring forceps or long clamp (e) and is connected to a negative pressure vacuum system (f).

Fig. 2.

The sponge fix around the drainage tube by silk suture in 2 sites or more.

Fig. 3.

Vacuum-assisted sponge drain final shape.