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Effectiveness of endosponge therapy for the management of presacral abscesses following rectal surgery

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Abstract

Background

Anastomotic leak after rectal surgery is reported in 9% (range 3–28%) of patients. The aim of our study was to evaluate the effectiveness of endosponge therapy for anastomotic. Endpoints were the rate of restored continuity and the functional bowel outcome after anastomotic leakage.

Methods

This was a multicenter retrospective observational cohort study. All patients with symptomatic anastomotic leakage after rectal surgery who had endosponge therapy between January 2012 and August 2017 were included. Functional bowel outcome was measured using the low anterior resection syndrome (LARS) score system.

Results

Twenty patients were included. Eighteen patients had low anterior resection (90%) for rectal cancer. A diverting ileostomy was performed at primary surgical intervention in 14 patients (70%). Fourteen patients (70%) were treated with neoadjuvant (chemo-)radiotherapy. The median time between primary surgical intervention and first endosponge placement was 21 (5–537) days. The median number of endosponge changes was 9 (2–28). The success rate of the endosponge treatment was 88% and the restored gastrointestinal continuity rate was 73%. A chronic sinus occurred in three patients (15%). All patients developed LARS, of which 77% reported major LARS.

Conclusions

Endosponge therapy is an effective treatment for the closure of presacral cavities with high success rate and leading to restored gastrointestinal continuity in 73%. However, despite endosponge therapy many patients develop major LARS.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands

    J. F. Huisman, E. J. van der Wouden & W. H. de Vos tot Nederveen Cappel

  2. Department of Surgery, Isala, Zwolle, The Netherlands

    H. L. van Westreenen

  3. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands

    H. F. A. Vasen

  4. Department of Surgery, IJsselland Hospital, Capelle aan de IJssel, The Netherlands

    E. J. R. de Graaf, P. G. Doornebosch & M. Vermaas

  5. Department of Gastroenterology and Hepatology, IJsselland Hospital, Capelle aan de IJssel, The Netherlands

    T. J. Tang & I. Schot

  6. Department of Epidemiology and Statistics, Isala, Zwolle, The Netherlands

    R. M. Brohet

Authors
  1. J. F. Huisman
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  2. H. L. van Westreenen
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  3. E. J. van der Wouden
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  4. H. F. A. Vasen
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  5. E. J. R. de Graaf
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  6. P. G. Doornebosch
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  7. T. J. Tang
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  8. I. Schot
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  9. R. M. Brohet
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  10. W. H. de Vos tot Nederveen Cappel
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  11. M. Vermaas
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Corresponding author

Correspondence to J. F. Huisman.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the medical ethics committee of Isala hospital (reference number: 171215) and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

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For this type of study, formal consent is not required.

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Huisman, J.F., van Westreenen, H.L., van der Wouden, E.J. et al. Effectiveness of endosponge therapy for the management of presacral abscesses following rectal surgery. Tech Coloproctol 23, 551–557 (2019). https://doi.org/10.1007/s10151-019-02007-9

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  • DOI: https://doi.org/10.1007/s10151-019-02007-9

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