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. 2023 Mar;18(1):128-134.
doi: 10.5114/wiitm.2022.121701. Epub 2022 Nov 30.

Dehiscence of colorectal anastomosis treated with noninvasive procedures

Jarosław Cwaliński  1 , Jacek Hermann  1 , Jacek Paszkowski  1 , Tomasz Banasiewicz  1
Affiliations

Dehiscence of colorectal anastomosis treated with noninvasive procedures

Jarosław Cwaliński et al. Wideochir Inne Tech Maloinwazyjne. 2023 Mar.

Abstract

Introduction: Most postoperative rectal leakages can be successfully treated with minimally invasive procedures. Endoscopic vacuum therapy supported by tissue adhesives or cellular growth stimulants closes even chronic anastomotic fistulas.

Aim: To present a treatment strategy for postoperative leakage of rectal anastomoses with noninvasive procedures.

Material and methods: From 2015 to 2020, a group of 25 patients with postoperative rectal leakage was enrolled for minimally invasive treatment. The indication for the therapy was anastomotic dehiscence not exceeding 1/2 of the bowel circuit and the absence of severe septic complications. All patients were healed with endoluminal vacuum therapy (EVT) supported by hemostatic clips, tissue adhesives or cellular growth stimulants.

Results: Complete drainage and reduction of leakage were achieved in 23 patients. The fistula was totally closed in 21 patients and in 2 of them it was restricted to a slit sinus. Two patients required revision surgery. Endoscopic treatment attempted within 7 days from leakage detection, as well as the size of the dehiscence less than 1/4 of the bowel circuit, increased the chance of full healing. In contrast, ultra low resection and neoadjuvant radiotherapy impaired the healing process, limiting the effectiveness of noninvasive therapy.

Conclusions: The minimally invasive approach successfully restricts anastomotic leakage and reduces the diameter of dehiscence. Early initiation of the therapy and the size of rupture determine the final results. The use of complementary endoscopic solutions, such as clips or tissue adhesives, increases the effectiveness of the noninvasive strategy.

Keywords: anastomotic dehiscence; endoluminal vacuum therapy; noninvasive treatment; rectal leak; tissue adhesive.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Effectiveness of leakage resorption depending on the start of treatment
Figure 2
Figure 2
Effectiveness of leakage resorption depending on the size of the anastomotic rupture
Figure 3
Figure 3
Effectiveness of leakage resorption depending on the location of the anastomosis
Figure 4
Figure 4
Effectiveness of leakage resorption depending on neoadjuvant radiotherapy
See this image and copyright information in PMC

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