The lady 72-years old, 10 days after anterior resection because of rectal cancer (T3N0M0) developed anastomotic leak accompanied by surgical site infection. Since she has "frozen abdomen" we did not perform diverting ileostomy. We placed EndoSponge and abdominal vacuum assisted abdominal closure with quite good abdominal wound healing.
Is EndoSponge placed properly? It was not possible to place it deeper in the anastomotic cavity. The negative pressure works.
Do you usually allow the patients to consume liquid diet during EndoSponge treatment?
Thanks for your help
I think will be a cause for complications, as greater opening in anastomosis, sepsis.
EndoSponge did well in our experience. Be sure that you leave the abscess cavity as small as possible, almost aligned with the rectal lumen, before give up the treatment.
There is much way for us to know the cons and pros of such new therapeutic modalities, and coming to a rational conclusion needs randomized controlled trials.
Interesante tema. Todos los grupos tenemos nuestra serie... No tengo experiencia con ese artículo, pero lo aprendido en fístulas digestivas es: verificar ausencia de oclusión distal en tubo digestivo, drenar colecciones y tutorizar trayecto.
Any outcome of your patient?
We have recently published the results of our broad experience (20 years) with this technique. With correct indication and technique it is safe and effective.
Kühn F, Wirth U, Zimmermann J, et al. Endoscopic vacuum therapy for in- and outpatient treatment of colorectal defects. Surg Endosc. 2021;35(12):6687-6695. doi:10.1007/s00464-020-08172-5
Kühn F, Hasenhütl SM, Hofmann FO, et al. Endoscopic Vacuum Therapy for Left-Sided Colorectal Anastomotic Leak Without Fecal Diversion [published online ahead of print, 2021 Oct 8]. Dis Colon Rectum. 2021;10.1097/DCR.0000000000001959. doi:10.1097/DCR.0000000000001959
Systematic review and meta-analysis:
Kühn F, Schardey J, Wirth U, et al. Endoscopic vacuum therapy for the treatment of colorectal leaks - a systematic review and meta-analysis [published online ahead of print, 2021 Nov 24]. Int J Colorectal Dis. 2021;10.1007/s00384-021-04066-7. doi:10.1007/s00384-021-04066-7
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