Endoscopic vacuum-assisted closure therapy for leakage of the lower gastrointestinal tract: multicenter experiences

Abstract

Background and study aims Only a few studies are available regarding endoscopic vacuum-assisted closure (E-VAC) therapy for the post-surgery leakage of the lower gastrointestinal tract. Patients and methods In this multicenter German study, we retrospectively analyzed patients treated with E-VAC therapy due to post-surgery leakage of the lower gastrointestinal tract from 2000-2020 at Hannover Medical School, University Medical Center Schleswig-Holstein, Campus Luebeck, and Robert Koch Hospital Gehrden. Results Overall, 147 patients were included in this study. Most patients had undergone tumor resections of the lower gastrointestinal tract (n = 88; 59.9 %). Median time to diagnosis of leakage was 10 days (interquartile range [IQR] 6-19). Median duration of E-VAC therapy was 14 days (IQR 8-27). Increase of C-reactive protein (CRP) levels significantly correlated with first diagnosis of leakage ( P < 0.001). E-VAC therapy led to closure or complete epithelialization of leakage in the majority of patients (n = 122; 83.0 %) and stoma reversal was achieved in 60.0 %. Stoma reversal was significantly more often achieved in patients with CRP levels ≤ 100 mg/L at first diagnosis compared to patients with CRP levels > 100 mg/L (78.4 % vs. 52.7 %; P = 0.012). Odds ratio for failure of stoma reversal was 3.36 in cases with CRP values > 100 mg/L ( P = 0.017). In total, leakage- and/ or E-VAC therapy-associated complications occurred in 26 patients (17.7 %). Minor complications included recurrent E-VAC dislocations and subsequent stenosis. Overall, 14 leakage- or E-VAC-associated deaths were observed most often due to sepsis. Conclusions E-VAC therapy due to post-surgery leakage of the lower gastrointestinal tract is safe and effective. High levels of CRP are a negative predictor of E-VAC therapy success.

Fig. 1

Development of CRP values.

Fig. 2

Fifty-four-year-old male patient who suffered from leakage of the rectal stump after low anterior resection (LAR) and cystectomy due to colorectal cancer (G2 pT4b pN0 (0 /15) L0 V0 Pn0 R0). a Endoscopic findings at diagnosis with leakage and a deep superinfected cavity into which a pigtail drainage had been introduced in beforehand. b E-VAC therapy was applied. After 18 days of therapy, which included five exchanges of the E-VAC system the patient showed adequate response resulting in cessation of therapy. c Granularized cavity as a sign of therapeutic response. d Final result with increasing closure of the leakage.

Fig. 3

Forest plot of risk groups to failure of stoma reversal.