Florian Kuehn1, Florian Janisch2, Frank Schwandner2, Guido Alsfasser2, Leif Schiffmann2,3, Michael Gock2, Ernst Klar2. 1. Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany. florian.kuehn@med.uni-rostock.de. 2. Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany. 3. Protestant Hospital Lippstadt, Wiedenbrücker Str. 33, 59555, Lippstadt, Germany.
Abstract
INTRODUCTION: Endoscopic vacuum therapy (EVT) has been established in Germany for the treatment of anastomotic leakage after rectal resection. Continuous or intermittent suction and drainage decrease bacterial contamination, secretion, and local edema promoting perfusion and granulation at the same time. However, data for use and long-term results of EVT in colorectal surgery are still scarce and are often limited by short-term follow-up. OBJECTIVES: Here, we aimed at analyzing the treatment spectrum and long-term outcome of EVT for defects of the lower gastrointestinal tract. METHODS: This is a retrospective single-center analysis of EVT for defects of the lower gastrointestinal tract of different etiology in 41 patients over a time period of 8 years (2007-2015) with a mean follow-up of 36 (2-89) months. RESULTS: In total, 426 polyurethane sponges were placed in lower GI defects of 41 patients (31 male, 10 female) with a median age of 70 years (range, 29-91). Most frequent indications for EVT were anastomotic leakage after rectal resection (n = 20), Hartmann's stump insufficiency (n = 12), and rectal perforation (n = 3). The median number of sponge insertions was six (range, 1-37) with a mean changing interval of 3 days (range, 1-5). Median time of therapy was 20 days. A successful vacuum therapy with local control of the septic focus was achieved in 18 of 20 patients (90 %) with anastomotic leakage after rectal resection and in nine of 12 patients with a Hartmann's stump insufficiency. In 15 of 19 (79 %) patients with a diverting stoma, take-down after successful treatment was possible. Median time to closure was 244 days (range, 152-488 days). CONCLUSION: To our knowledge, this retrospective observation of EVT application for rectal lesions represents the largest patient series in literature. EVT has earned its indication in complication management after colorectal surgery and can achieve a successful control of a local septic focus in the majority of patients.
INTRODUCTION: Endoscopic vacuum therapy (EVT) has been established in Germany for the treatment of anastomotic leakage after rectal resection. Continuous or intermittent suction and drainage decrease bacterial contamination, secretion, and local edema promoting perfusion and granulation at the same time. However, data for use and long-term results of EVT in colorectal surgery are still scarce and are often limited by short-term follow-up. OBJECTIVES: Here, we aimed at analyzing the treatment spectrum and long-term outcome of EVT for defects of the lower gastrointestinal tract. METHODS: This is a retrospective single-center analysis of EVT for defects of the lower gastrointestinal tract of different etiology in 41 patients over a time period of 8 years (2007-2015) with a mean follow-up of 36 (2-89) months. RESULTS: In total, 426 polyurethane sponges were placed in lower GI defects of 41 patients (31 male, 10 female) with a median age of 70 years (range, 29-91). Most frequent indications for EVT were anastomotic leakage after rectal resection (n = 20), Hartmann's stump insufficiency (n = 12), and rectal perforation (n = 3). The median number of sponge insertions was six (range, 1-37) with a mean changing interval of 3 days (range, 1-5). Median time of therapy was 20 days. A successful vacuum therapy with local control of the septic focus was achieved in 18 of 20 patients (90 %) with anastomotic leakage after rectal resection and in nine of 12 patients with a Hartmann's stump insufficiency. In 15 of 19 (79 %) patients with a diverting stoma, take-down after successful treatment was possible. Median time to closure was 244 days (range, 152-488 days). CONCLUSION: To our knowledge, this retrospective observation of EVT application for rectal lesions represents the largest patient series in literature. EVT has earned its indication in complication management after colorectal surgery and can achieve a successful control of a local septic focus in the majority of patients.
Authors: Nikolaj Nerup; John Lykkegaard Johansen; Ghalib Ali Abod Alkhefagie; Pierre Maina; Kenneth Højsgaard Jensen Journal: Dan Med J Date: 2013-04 Impact factor: 1.240
Authors: M Brangewitz; T Voigtländer; F A Helfritz; T O Lankisch; M Winkler; J Klempnauer; M P Manns; A S Schneider; J Wedemeyer Journal: Endoscopy Date: 2013-06-03 Impact factor: 10.093
Authors: Jennifer Blumetti; Vivek Chaudhry; Jose R Cintron; John J Park; Slawomir Marecik; Jacqueline L Harrison; Leela M Prasad; Herand Abcarian Journal: World J Surg Date: 2014-04 Impact factor: 3.352
Authors: P J van Koperen; M I van Berge Henegouwen; C Rosman; C M Bakker; P Heres; J F M Slors; W A Bemelman Journal: Surg Endosc Date: 2008-11-27 Impact factor: 4.584
Authors: W A A Borstlap; G D Musters; L P S Stassen; H L van Westreenen; D Hess; S van Dieren; S Festen; E J van der Zaag; P J Tanis; W A Bemelman Journal: Surg Endosc Date: 2017-06-29 Impact factor: 4.584
Authors: Gunnar Loske; Tobias Schorsch; Frank Rucktaeschel; Wolfgang Schulze; Burkhard Riefel; Vera van Ackeren; Christian Theodor Mueller Journal: Endosc Int Open Date: 2018-07-04