Abstract
Purpose
Anastomotic or stump leakage is a common and serious complication of colorectal surgery. The objective of this study was to retrospectively investigate the clinical use and potential benefit of transanal rinsing treatment (TRT) using an innovative rinsing catheter (RC) after treatment with endoscopic vacuum therapy (EVT).
Methods
Patients with leakage after low colorectal surgery who had been treated with EVT were retrospectively analyzed. A subset of patients was trained to perform TRT with a specially developed RC. We investigated the rate of complete healing of the leakage, septic complications, failure of the therapy, surgical revisions, ostomy closure rate, and complications related to endoscopic therapy.
Results
Between February 2007 and January 2014, 98 patients with local complications after low colorectal surgery, treated with EVT, were identified. Eighty-nine patients were analyzed (the treatment of nine patients was stopped due to medical or technical problems): 31 patients were treated with EVT only (EVT group) and 58 patients with EVT followed by TRT (EVT/TRT group). Complete healing of the leakage was significantly better in the EVT/TRT group [84% vs. 58% (p < 0.009)], and significantly fewer septic complications needing surgical revision were detected [3% vs. 11% (p = 0.001)]. No significant differences regarding endoscopy-related complications and ostomy closure were found between EVT and EVT/TRT patients.
Conclusions
The use of patient-administered TRT with an innovative, customized RC after EVT is technically feasible and reliable and significantly improves therapeutic results. Further prospective trials with larger patient groups are needed to validate the results of our study.
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References
Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P (1999) Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 86:927–931
Farke S, Gögler H (2000) Anastomoseninsuffizienz nach kontinenzerhaltenden Rektumresektionen. Coloproctology 22:161–169
Karliczek A, Jesus EC, Matos D, Castro AA, Atallah AN, Wiggers T (2006) Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Color Dis 8:259–265
Kessler H, Hermanek P Jr, Wiebelt H (1993) Operative mortality in carcinoma of the rectum. Results of the German Multicentre Study. Int J Color Dis 8:158–166
Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W (2017) Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg 41:277–284
Thomas MS, Margolin DA (2016) Management of colorectal anastomotic leak. Clin Colon Rectal Surg 29:138–144
Qu H, Liu Y, Bi DS (2015) Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 29:3608–3617
Sparreboom CL, van Groningen JT, Lingsma HF, Wouters M, Menon AG, Kleinrensink GJ, Jeekel J, Lange JF, Dutch ColoRectal Audit g (2018) Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum 61:1258–1266
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Buchler MW (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351
Clifford RE, Fowler H, Govindarajah N, Vimalachandran D, Sutton PA (2019) Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage. Surg Endosc 33(4):1049–1065
Shalaby M, Thabet W, Buonomo O, Lorenzo ND, Morshed M, Petrella G, Farid M, Sileri P (2018) Transanal tube drainage as a conservative treatment for anastomotic leakage following a rectal resection. Ann Coloproctol 34:317–321
Weidenhagen R, Grutzner K, Weilbach C, Speisberg F, Schildberg F (2003) Endoscopic vacuum assisted closure of anastomotic leakage after anterior resection of the rectum - a new method. Surg Endosc 17:S92
Riss S, Stift A, Kienbacher C, Dauser B, Haunold I, Kriwanek S, Radlsboek W, Bergmann M (2010) Recurrent abscess after primary successful endo-sponge treatment of anastomotic leakage following rectal surgery. World J Gastroenterol 16:4570–4574
Strangio G, Zullo A, Ferrara EC, Anderloni A, Carlino A, Jovani M, Ciscato C, Hassan C, Repici A (2015) Endo-sponge therapy for management of anastomotic leakages after colorectal surgery: a case series and review of literature. Dig Liver Dis 47:465–469
Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW (2008) Endoluminal vacuum therapy for the treatment of anastomotic leakage after anterior rectal resection. Rozhl Chir 87:397–402
Wallstabe I, Nguyen P, Schiefke I, Weimann A (2019) Endoscopic vacuum therapy with open-pore film drainage for colonic anastomotic leakage in a morbidly obese patient. Endoscopy 51:E51–E52
Loske G, Schorsch T, Rucktaeschel F, Schulze W, Riefel B, van Ackeren V, Mueller CT (2018) Open-pore film drainage (OFD): a new multipurpose tool for endoscopic negative pressure therapy (ENPT). Endosc Int Open 6:E865–E871
van Koperen PJ, van Berge Henegouwen MI, Rosman C, Bakker CM, Heres P, Slors JF, Bemelman WA (2009) The Dutch multicenter experience of the endo-sponge treatment for anastomotic leakage after colorectal surgery. Surg Endosc 23:1379–1383
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All authors contributed to study conception and design. Material preparation, data collection, and analysis were performed by Marcus Kantowski, Andreas Kunze, Michael Tachezy, and Eugen Bellon. The first draft of the manuscript was written by Marcus Kantowski, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.
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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Kantowski, M., Kunze, A., Bellon, E. et al. Improved colorectal anastomotic leakage healing by transanal rinsing treatment after endoscopic vacuum therapy using a novel patient-applied rinsing catheter. Int J Colorectal Dis 35, 109–117 (2020). https://doi.org/10.1007/s00384-019-03456-2
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DOI: https://doi.org/10.1007/s00384-019-03456-2