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Surgical Endoscopy

, Volume 22, Issue 8, pp 1818–1825 | Cite as

Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method

  • Rolf WeidenhagenEmail author
  • Klaus Uwe Gruetzner
  • Timm Wiecken
  • Fritz Spelsberg
  • Karl-Walter Jauch
Article

Abstract

Background

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.

Method

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.

Results

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.

Conclusions

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.

Keywords

Endoscopic Closure Anastomotic Leakage Resection Rectum 

Notes

Acknowledgments

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.

References

  1. 1.
    Hallböök O, Sjodahl R (1996) Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 83:60–62PubMedCrossRefGoogle Scholar
  2. 2.
    Heald RJ, Karanjia ND (1992) Results of radical surgery for rectal cancer. World J Surg 16: 848–857PubMedCrossRefGoogle Scholar
  3. 3.
    Schrock TR, Deveney CW, Dunphy JE (1973) Factor contributing to leakage of colonic anastomoses. Ann Surg 177:513–518PubMedCrossRefGoogle Scholar
  4. 4.
    Goligher JC, Graham NG, De Dombal FT (1970) Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg 57:109–108PubMedCrossRefGoogle Scholar
  5. 5.
    Mileski WJ, Joehl RJ, Rege RV, Nahrwold DL (1988) Treatment of anastomotic leakage following low anterior colon resection. Arch Surg 123:968–971PubMedGoogle Scholar
  6. 6.
    Fielding LP, Stewart-Brown S, Blesovsky L, Kearney G (1980) Anastomotic integrity after operations for large-bowel cancer: a multicentre study. Br Med J 281:411–414PubMedCrossRefGoogle Scholar
  7. 7.
    Graf W, Glimelius B, Bergstrom R, Pahlman L (1991) Complications after double and single stapling in rectal surgery. Eur J Surg 157:543–547PubMedGoogle Scholar
  8. 8.
    Tuson JR, Everett WG (1990) A retrospective study of colostomies, leaks and strictures after colorectal anastomosis. Int J Colorectal Dis 5:44–48PubMedCrossRefGoogle Scholar
  9. 9.
    Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H, Working Group “Colon/Rectum Carcinoma” (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92:1137–1142PubMedCrossRefGoogle Scholar
  10. 10.
    Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358PubMedCrossRefGoogle Scholar
  11. 11.
    Pakkastie TE, Luukkonen PE, Jarvinen HJ (1994) Anastomotic leakage after anterior resection of the rectum. Eur J Surg 160:293–297 discussion 299–230PubMedGoogle Scholar
  12. 12.
    Ravo B (1988) Colorectal anastomotic healing and intracolonic bypass procedure. Surg Clin North Am 68:1267–1294PubMedGoogle Scholar
  13. 13.
    Hawley PR (1973) Causes and prevention of colonic anastomotic breakdown. Dis Colon Rectum 16:272–277PubMedCrossRefGoogle Scholar
  14. 14.
    Morgenstern L, Yamakawa T, Ben-Shoshan M, Lippman H (1972) Anastomotic leakage after low colonic anastomosis. Clinical and experimental aspects. Am J Surg 23:104–109Google Scholar
  15. 15.
    Cade D, Gallagher P, Schofield PF, Turner L (1981) Complications of anterior resection of the rectum using the EEA stapling device. Br J Surg 68:339–340PubMedCrossRefGoogle Scholar
  16. 16.
    Heald RJ, Leicester RJ (1981) The low stapled anastomosis. Br J Surg 68:333–337PubMedCrossRefGoogle Scholar
  17. 17.
    Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P (1999) Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 189:554–559PubMedCrossRefGoogle Scholar
  18. 18.
    Luna Perez P, Rodriguez Ramirez S, Gonzalez Macouzet J, Rodriguez Coria DF (1999) Treatment of anastomotic leakage following low anterior resection for rectal adenocarcinoma. Rev Invest Clin 51:23–29PubMedGoogle Scholar
  19. 19.
    Pera M, Delgado S, Garcia-Valdecasas JC, Pera M, Castells A, Pique JM, Bombuy E, Lacy AM (2002) The management of leaking rectal anastomoses by minimally invasive techniques. Surg Endosc 16:603–606PubMedCrossRefGoogle Scholar
  20. 20.
    Wolf AM, Henne-Bruns D (2002) Anastomoseninsuffizienz im Gastrointestinaltrakt: Diagnostik und Therapie. Chirurg 73:394–405 quiz 406–407PubMedCrossRefGoogle Scholar
  21. 21.
    Willis S, Stumpf M (2004) Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt. Chirurg 75:1071–1078PubMedCrossRefGoogle Scholar
  22. 22.
    Weidenhagen R, Gruetzner K, Weilbach C, Spelsberg 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
  23. 23.
    Agrama HM, Blackwood JM, Brown CS, Machiedo GW, Rush BF (1976) Functional longevity of intraperioneal drains: an experimental evaluation. Am J Surg 132:418–421PubMedCrossRefGoogle Scholar
  24. 24.
    Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP (2004) Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg 114:1086–1096 discussion 1097PubMedCrossRefGoogle Scholar
  25. 25.
    Morykwas MJ, Argenta LC, Shelton Brown EI, McGuirt W (1997) Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38:553–562PubMedCrossRefGoogle Scholar
  26. 26.
    Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38:563–576 discussion 577PubMedCrossRefGoogle Scholar
  27. 27.
    Matthiessen P, Hallbook O, Rutegard J, Sjodahl R (2006) Population-based study of risk factors for postoperative death after anterior resection of the rectum. Br J Surg 93:498–503PubMedCrossRefGoogle Scholar
  28. 28.
    Guenaga K, Lustosa S, Saad S, Saconato H, Matos D (2007) Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev 1:CD004647PubMedGoogle Scholar
  29. 29.
    Pross M, Manger T, Reinheckel T, Mirow L, Kunz D, Lippert H (2000) Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc 51:73–76PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Rolf Weidenhagen
    • 1
    Email author
  • Klaus Uwe Gruetzner
    • 2
  • Timm Wiecken
    • 1
  • Fritz Spelsberg
    • 1
  • Karl-Walter Jauch
    • 1
  1. 1.Department of SurgeryKlinikum Grosshadern, Ludwig-Maximilian-University of MunichMunichGermany
  2. 2.Clinic for Visceral-, Vascular and Transplant SurgeryUniversity Witten/Herdecke, Clinic Cologne-MerheimCologneGermany

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