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Improved colorectal anastomotic leakage healing by transanal rinsing treatment after endoscopic vacuum therapy using a novel patient-applied rinsing catheter

  • Marcus Kantowski
  • Andreas Kunze
  • Eugen Bellon
  • Thomas Rösch
  • Utz Settmacher
  • Michael TachezyEmail author
Original Article
  • 33 Downloads

Abstract

Purpose

Anastomotic or stump leakage is a common and serious complication of colorectal surgery. The objective of this study was to retrospectively investigate the clinical use and potential benefit of transanal rinsing treatment (TRT) using an innovative rinsing catheter (RC) after treatment with endoscopic vacuum therapy (EVT).

Methods

Patients with leakage after low colorectal surgery who had been treated with EVT were retrospectively analyzed. A subset of patients was trained to perform TRT with a specially developed RC. We investigated the rate of complete healing of the leakage, septic complications, failure of the therapy, surgical revisions, ostomy closure rate, and complications related to endoscopic therapy.

Results

Between February 2007 and January 2014, 98 patients with local complications after low colorectal surgery, treated with EVT, were identified. Eighty-nine patients were analyzed (the treatment of nine patients was stopped due to medical or technical problems): 31 patients were treated with EVT only (EVT group) and 58 patients with EVT followed by TRT (EVT/TRT group). Complete healing of the leakage was significantly better in the EVT/TRT group [84% vs. 58% (p < 0.009)], and significantly fewer septic complications needing surgical revision were detected [3% vs. 11% (p = 0.001)]. No significant differences regarding endoscopy-related complications and ostomy closure were found between EVT and EVT/TRT patients.

Conclusions

The use of patient-administered TRT with an innovative, customized RC after EVT is technically feasible and reliable and significantly improves therapeutic results. Further prospective trials with larger patient groups are needed to validate the results of our study.

Keywords

Leakage Complication management Vacuum therapy Surgery Rectal cancer 

Notes

Author contributions

All authors contributed to study conception and design. Material preparation, data collection, and analysis were performed by Marcus Kantowski, Andreas Kunze, Michael Tachezy, and Eugen Bellon. The first draft of the manuscript was written by Marcus Kantowski, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of Interest

The authors have no conflicts of interest or financial ties to disclose.

Ethical Approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

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References

  1. 1.
    Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P (1999) Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 86:927–931CrossRefGoogle Scholar
  2. 2.
    Farke S, Gögler H (2000) Anastomoseninsuffizienz nach kontinenzerhaltenden Rektumresektionen. Coloproctology 22:161–169CrossRefGoogle Scholar
  3. 3.
    Karliczek A, Jesus EC, Matos D, Castro AA, Atallah AN, Wiggers T (2006) Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Color Dis 8:259–265CrossRefGoogle Scholar
  4. 4.
    Kessler H, Hermanek P Jr, Wiebelt H (1993) Operative mortality in carcinoma of the rectum. Results of the German Multicentre Study. Int J Color Dis 8:158–166CrossRefGoogle Scholar
  5. 5.
    Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W (2017) Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg 41:277–284CrossRefGoogle Scholar
  6. 6.
    Thomas MS, Margolin DA (2016) Management of colorectal anastomotic leak. Clin Colon Rectal Surg 29:138–144CrossRefGoogle Scholar
  7. 7.
    Qu H, Liu Y, Bi DS (2015) Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 29:3608–3617CrossRefGoogle Scholar
  8. 8.
    Sparreboom CL, van Groningen JT, Lingsma HF, Wouters M, Menon AG, Kleinrensink GJ, Jeekel J, Lange JF, Dutch ColoRectal Audit g (2018) Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum 61:1258–1266CrossRefGoogle Scholar
  9. 9.
    Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Buchler MW (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351CrossRefGoogle Scholar
  10. 10.
    Clifford RE, Fowler H, Govindarajah N, Vimalachandran D, Sutton PA (2019) Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage. Surg Endosc 33(4):1049–1065CrossRefGoogle Scholar
  11. 11.
    Shalaby M, Thabet W, Buonomo O, Lorenzo ND, Morshed M, Petrella G, Farid M, Sileri P (2018) Transanal tube drainage as a conservative treatment for anastomotic leakage following a rectal resection. Ann Coloproctol 34:317–321CrossRefGoogle Scholar
  12. 12.
    Weidenhagen R, Grutzner K, Weilbach C, Speisberg F, Schildberg F (2003) Endoscopic vacuum assisted closure of anastomotic leakage after anterior resection of the rectum - a new method. Surg Endosc 17:S92Google Scholar
  13. 13.
    Riss S, Stift A, Kienbacher C, Dauser B, Haunold I, Kriwanek S, Radlsboek W, Bergmann M (2010) Recurrent abscess after primary successful endo-sponge treatment of anastomotic leakage following rectal surgery. World J Gastroenterol 16:4570–4574CrossRefGoogle Scholar
  14. 14.
    Strangio G, Zullo A, Ferrara EC, Anderloni A, Carlino A, Jovani M, Ciscato C, Hassan C, Repici A (2015) Endo-sponge therapy for management of anastomotic leakages after colorectal surgery: a case series and review of literature. Dig Liver Dis 47:465–469CrossRefGoogle Scholar
  15. 15.
    Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW (2008) Endoluminal vacuum therapy for the treatment of anastomotic leakage after anterior rectal resection. Rozhl Chir 87:397–402PubMedGoogle Scholar
  16. 16.
    Wallstabe I, Nguyen P, Schiefke I, Weimann A (2019) Endoscopic vacuum therapy with open-pore film drainage for colonic anastomotic leakage in a morbidly obese patient. Endoscopy 51:E51–E52CrossRefGoogle Scholar
  17. 17.
    Loske G, Schorsch T, Rucktaeschel F, Schulze W, Riefel B, van Ackeren V, Mueller CT (2018) Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT). Endosc Int Open 6:E865–E871CrossRefGoogle Scholar
  18. 18.
    van Koperen PJ, van Berge Henegouwen MI, Rosman C, Bakker CM, Heres P, Slors JF, Bemelman WA (2009) The Dutch multicenter experience of the endo-sponge treatment for anastomotic leakage after colorectal surgery. Surg Endosc 23:1379–1383CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinic of Interdisciplinary EndoscopyUniversity Hospital Hamburg-EppendorfHamburgGermany
  2. 2.Clinic for ObstetricsJena University HospitalJenaGermany
  3. 3.Clinic for General, Visceral and Vascular SurgeryJena University HospitalJenaGermany
  4. 4.Department of General, Visceral and Thoracic SurgeryUniversity Hospital Hamburg-EppendorfHamburgGermany

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