Endoscopic vacuum therapy for treatment of large distal anastomotic dehiscence after colorectal surgery

• Autores: Mansilla-Vivar, Rodrigo, Milluzzo, Sebastian Manuel, Pesatori, Eugenia Vittoria, Cesaro, Paola, Bizzotto, Alessandra, Lovera, Mauro, Olivari, Nicola, Spada, Cristiano, Segovia, Eduardo
• Formato: artículo
• Fecha de Publicación: 2024
• Institución: Sociedad de Gastroenterología del Perú
• Repositorio: Revista de Gastroenterología del Perú
• Lenguaje: español
• OAI Identifier: oai:ojs.revistagastroperu.com:article/1704
• Enlace del recurso: https://revistagastroperu.com/index.php/rgp/article/view/1704
• Nivel de acceso: acceso abierto
• Materia: Fuga anastomótica; Dehiscencia de la herida operatoria; Cirugía colorrectal; Endoscopía; Anastomotic leak; Surgical wound dehiscence; Colorectal surgery; Endoscopy

Background: Management of anastomotic dehiscences following colorectal surgery is a topic of debate. In this context, endoluminal vacuum therapy offers promising results. Objective: To analyze the efficacy and feasibility of endoluminal vacuum therapy in distal anastomotic dehiscences after colorectal surgery. Materials and methods: This study is a descriptive case series that evaluates patients with anastomotic dehiscences over a period of 18 months. All patients were treated with Endo-sponge™ (Braun Medical, Hessen, Germany). Results: Fourteen patients were included in the final analysis. The indications for endoluminal vacuum therapy were Hartmann's stump insufficency (n=6), anastomotic leakage after laparoscopic total mesorectal excision (n=4), and anastomotic dehiscence after transanal total mesorectal excision (n=4). A total of 204 sponges were placed per patient (median 12.5, range 1-33). Complete resolution was achieved in 9 patients (57.1%) in a mean time of 108 days (range 15-160 days). In the sub-analysis, patients with acute dehiscence (<3 months) achieved complete resolution in 80% (8/10), whereas no patient with chronic defects reached resolution (0/4). A low complication rate (7%) was recorded. Conclusion: Endoluminal vacuum therapy appears to be a feasible and safe treatment with a high success rate in patients with large acute colorectal anastomotic defects.