Endoscopic Vacuum Therapy for Left-Sided Colorectal Anastomotic Leak Without Fecal Diversion.

BACKGROUND Endoscopic vacuum therapy for the treatment of rectal anastomotic leak has been shown to be effective and safe. The majority of patients are treated after fecal diversion to avoid further septic complications. OBJECTIVE To report the effectiveness of endoscopic vacuum therapy for rectal anastomotic leak without diversion compared to secondary stoma creation. DESIGN Retrospective cohort analysis. SETTINGS University hospital, single-center. PATIENTS Patients undergoing sigmoid or rectal resection without fecal diversion during primary surgery who were treated with endoscopic vacuum therapy for clinically relevant anastomotic leak. MAIN OUTCOME MEASURES Treatment success (sepsis control, granulation and closure of the leak cavity, no subsequent interventional or surgical procedure required); treatment duration; complications associated with endoscopic vacuum therapy; outpatient treatment; restoration of intestinal continuity in diverted patients. RESULTS Fifty-seven patients were included. In 20 patients (35%), endoscopic vacuum therapy was initiated without secondary diversion since the leak was extra-peritoneal, and the sponge could be placed into the leak cavity with an adequate seal towards the lumen. In 18 patients (90%), this approach was successful. None of these patients required subsequent diversion in the further course of their disease. In two patients, secondary diversion was necessary due to treatment-failure. Balloon dilatation for luminal stenosis was required in two patients. Comparing patient and treatment characteristics of patients with and without a stoma including treatment success and duration, no significant differences were found. Restoration of intestinal continuity was achieved in 69% of diverted patients. LIMITATIONS Un-randomized, retrospective study design; confounding factors of treatment assignment; low patient numbers and short follow-up of diverted patients; low statistical power. CONCLUSION In this single institution study, endoscopic vacuum therapy for rectal anastomotic leak was successful in 90% of patients without diversion with regards to sepsis control, granulation of the leak cavity, avoidance of surgery, and long-term stoma-free survival. See Video Abstract at http://links.lww.com/DCR/B737.