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Vol. 42. Issue 5.
Pages 314-315 (May 2019)
Vol. 42. Issue 5.
Pages 314-315 (May 2019)
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Endoluminal endoscopic therapy with Endo-Sponge® system in the management of anastomotic dehiscence after colorectal surgery
Terapia endoscópica endoluminal con sistema Endo-Sponge® en el manejo de dehiscencia de anastomosis tras cirugía colorrectal
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Leire Parapar Álvarez
Corresponding author
leire.parapar@gmail.com

Corresponding author.
, Sonia Antón García, Carmen Argüelles Martínez de la Vega
Sección de Digestivo, Hospital Universitario San Agustín, Avilés, Asturias, Spain
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Anastomotic leakage is a serious complication of colorectal surgery. It occurs in 1–24%1,2 of cases after a previous low resection. The associated morbidity and mortality rates range from 6% to 22%.1,3 Patients receiving radiotherapy or neoadjuvant chemotherapy have a higher risk of leakage, with the need for a permanent stoma in up to 62% of cases.4,5

Treatment is difficult and may require invasive techniques with disappointing results. A minimally invasive alternative to surgical strategies is endoluminal vacuum therapy with Endo-Sponge®, to reduce the size of the cavity, limit pelvic sepsis and reduce the risk of stoma.1–5

Our patient was a 43-year-old male diagnosed with adenocarcinoma of the medial rectus. He had received neoadjuvant chemotherapy and radiotherapy with subsequent intervention involving low anterior resection by combined laparoscopic/trans-anal approach (TaTME [trans-anal total mesorectal excision]) with mechanical side-to-end anastomosis and ileostomy for protection. At 48h, he developed pyrexia and elevated levels of laboratory infection parameters (CRP, procalcitonin and leucocytosis with left shift). A computed tomography (CT) scan showed a pre-sacral collection 7×4×7cm in size. Proctoscopy (Fig. 1) showed the integrity of the anastomosis and a break in continuity communicating with a drain-hole in the blind loop (Fig. 2). Endo-Sponge® device was positioned (Fig. 3) replacing it every 48–72h. After five replacements, there was abundant granulation tissue and absence of purulent discharge (Fig. 4). The patient remained apyrexial with return to normal of laboratory values and so was discharged after a month in hospital. He is currently awaiting reconstruction surgery.

Figure 1.

Proctoscopy. Image of anastomosis and collection in blind loop.

(0.12MB).
Figure 2.

Interior of the cavity in the blind loop.

(0.12MB).
Figure 3.

Placement of Endo-Sponge® system with endoscopic view.

(0.1MB).
Figure 4.

Anastomosis after endoscopic vacuum therapy.

(0.11MB).

Endoluminal vacuum therapy with Endo-Sponge® is a safe and effective technique which should be considered as treatment for anastomotic fistulas/presacral collections after colorectal surgery.

References
[1]
W.S. Lee, S.H. Yun, Y.N. Roh, H.R. Yun, W.Y. Lee, Y.B. Cho, et al.
Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer.
World J Surg, 32 (2008), pp. 1124-1129
[2]
P. Matthiessen, O. Hallbook, M. Andersson, J. Rutegård, R. Sjödahl.
Risk factors for anastomotic leakage after anterior resection of the rectum.
Colorectal Dis, 6 (2004), pp. 462-469
[3]
H. Ptok, F. Marusch, F. Meyer, D. Schubert, I. Gastinger, H. Lippert, Study Group Colon/Rectum Carcinoma (Primary Tumour).
Impact of anastomotic leakage on oncological outcome after rectal cancer resection.
Br J Surg, 94 (2007), pp. 1548-1554
[4]
M. Den Dulk, M. Smit, K.C. Peeters, E.M. Kranenbarg, H.J. Rutten, T. Wiggers, Dutch Colorectal Cancer Group, et al.
A multivariate analysis of limiting factors for estoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study.
Lancet Oncol, 8 (2007), pp. 297-303
[5]
A. Mussetto, R. Arena, A. Buzzi, L. Fuccio, S. Dari, M.L. Brancaccio, et al.
Long-term efficacy of vacuum-assisted therapy (Endo-SPONGE) in large anastomotic leakages following anterior rectal resection.
Ann Gastroenterol, 30 (2017), pp. 649-653

Please cite this article as: Parapar Álvarez L, Antón García S, Argüelles Martínez de la Vega C. Terapia endoscópica endoluminal con sistema Endo-Sponge® en el manejo de dehiscencia de anastomosis tras cirugía colorrectal. Gastroenterol Hepatol. 2019;42:314–315.

Copyright © 2019. Elsevier España, S.L.U.. All rights reserved
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