Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method
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Conservative treatment of anastomotic leakage after anterior resection of the rectum seems to be possible in patients who have no occurrence of generalized peritonitis. This report describes a new method of endoscopic management of large anastomotic leakage in these patients.
The main feature of this new method is the endoscopically assisted placement of an open-cell sponge connected to a vacuum device into the abscess cavity via an introducer device. The sponge system is changed every 48–72 h.
Twenty-nine patients with an anastomotic leakage after anterior resection were treated with the endoscopic vacuum therapy. The total duration of endovac therapy was 34.4 ± 19.4 days. The total number of endoscopic sessions per patient was 11.4 ± 6.3. In 21 of the 29 patients, a protecting stoma was created at the primary operation. Four patients were treated successfully without the need of a secondary stoma. Definitive healing was achieved in 28 of the 29 patients.
Endoscopic vacuum-assisted closure is a new efficacious modality for treating anastomotic leakage following anterior resection due to an effective control of the septic focus. Further studies will show if it is possible to reduce the high mortality rate of patients with anastomotic leakage through the avoidance of surgical reinterventions while at the same time preserving the sphincter function.
KeywordsEndoscopic Closure Anastomotic Leakage Resection Rectum
The authors thank Edith Guse, Barbara Kitz, and the whole team of the Surgial Endoscopy Unit Grosshadern for their assistance and support in the development and establishment of this method. The authors also thank Heidi Leicht for her assistance in manuscript preparation.
Conflict of interest Worldwide patent is pending for this method (R. Weidenhagen and U. Grützner). A license agreement for this method with KCI, San Antonio, Texas, was signed in 2002 and terminated in 2004. A new license agreement is signed in 2007 with BBraun Melsungen AG, Germany.
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