Abstract
Background
Symptomatic rectal stump leakage (RSL) is a serious complication after discontinuity resection and requires immediate surgical, interventional, or endoscopic therapy. Re-operations are associated with high morbidity and mortality in these mostly very ill patients. Endoscopic vacuum therapy (EVT) has been established for management of anastomotic leakage; however, its effectiveness for RSL treatment has not been analyzed in detail yet.
Methods
A retrospective analysis of patients treated with EVT for RSL between 2001 and 2018 analyzing factors predicting therapy success and duration was carried out.
Results
Fifty-six patients with RSL at a median age of 66 years were included. Of these, 18 patients (32%) had been referred for EVT from external departments or institutions. RSL was associated with a relevant clinical deterioration in all patients, and 55 patients (98%) had been classified as ASA 3 and 4, preoperatively. In 9 patients (16%), additional surgical revision was necessary with initiation of EVT. In 47 patients (84%), EVT was successful and local control of the inflammatory focus was achieved. The median duration of therapy was 20 days. Two patients (4%) suffered from minor EVT-associated bleeding that was endoscopically controlled. Preoperative radiation of the pelvis was significantly associated with EVT failure (P = 0.035), whereas patient age represented a predictive factor for therapy length (P = 0.039). In 12 patients (21%), restoration of intestinal continuity was achieved in the further course.
Conclusions
We present the first specific series on EVT for RSL. EVT for RSL was shown to be an effective and safe minimal-invasive treatment option, avoiding surgical revision in the majority of patients.
Similar content being viewed by others
References
Barbieux J, Plumereau F, Hamy A (2016) Current indications for the Hartmann procedure. J Visc Surg 153:31–38
Shalaby M, Emile S, Elfeki H, Sakr A, Wexner SD, Sileri P (2018) Systematic review of endoluminal vacuum-assisted therapy as salvage treatment for rectal anastomotic leakage. BJS Open 3:153–160
Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW (2007) Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 22:1818–1825
Kuehn F, Janisch F, Schwandner F, Alsfasser G, Schiffmann L, Gock M, Klar E (2016) Endoscopic Vacuum Therapy in Colorectal Surgery. J Gastrointest Surg 20:328–334
Schiffmann L, Wedermann N, Schwandner F, Gock M, Klar E, Kühn F (2019) Neoadjuvant radio-chemotherapy prolongs healing of anastomotic leakage after rectal resection treated with endoscopic vacuum therapy. Therap Adv Gastroenterol 12:1756284819877606
Royo-Aznar A, Moro-Valdezate D, Martín-Arévalo J, Pla-Martí V, García-Botello S, Espín-Basany E, Espí-Macías A (2018) Reversal of Hartmann's procedure: a single-centre experience of 533 consecutive cases. Colorectal Dis 20:631–638
van de Wall BJ, Draaisma WA, Schouten ES, Broeders IA, Consten EC (2010) Conventional and laparoscopic reversal of the Hartmann procedure: a review of literature. J Gastrointest Surg 14:743–752
Tokode OM, Akingboye A, Coker O (2011) Factors affecting reversal following Hartmann’s procedure: experience from two district general hospitals in the UK. Surg Today 41:79–83
Hodgson R, An V, Stupart DA, Guest GD, Watters DA (2016) Who gets Hartmann’s reversed in a regional centre? Surgeon 14:184–189
Banerjee S, Leather AJ, Rennie JA, Samano N, Gonzalez JG, Papagrigoriadis S (2005) Feasibility and morbidity of reversal of Hartmann’s. Colorectal Dis 7:545–549
Roig JV, Cantos M, Balciscueta Z, Uribe N, Espinosa J, Roselló V, García-Calvo R, Hernandis J, Landete F; Sociedad Valenciana de Cirugía Cooperative Group (2011) Hartmann’s operation: how often is it reversed and at what cost? A Multicentre Study Colorectal Dis 13:e396–402
Acknowledgements
The authors sincerely thank Rolf Weidenhagen, MD, Fritz Spelsberg, MD, Klaus Uwe Grützner, MD, and Christian Schneider, MD, for their outstanding preliminary work (technical development, clinical establishment, and scientific work) in the field of endoscopic vacuum therapy at our department and thank Hans-Martin Hornung, MD, for his dedicated IT and data administration.
Funding
No funding was received for the present study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
There are no financial or personal conflicts of any of the authors. Drs. Florian Kühn, Julia Zimmermann, Nicola Beger, Ulrich Wirth, Sandro M. Hasenhütl, Moritz Drefs, Chen Chen, Maria Burian, W. Konrad Karcz, Markus Rentsch, Jens Werner, and Tobias S. Schiergens have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kühn, F., Zimmermann, J., Beger, N. et al. Endoscopic vacuum therapy for treatment of rectal stump leakage. Surg Endosc 35, 1749–1754 (2021). https://doi.org/10.1007/s00464-020-07569-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-07569-6