Endoscopic vacuum therapy for treatment of rectal stump leakage

Kuehn, Florian; Zimmermann, Julia; Beger, Nicola; Wirth, Ulrich; Hasenhuetl, Sandro M.; Drefs, Moritz; Chen, Chen; Burian, Maria; Karcz, W. Konrad; Rentsch, Markus; Werner, Jens und Schiergens, Tobias S. (2020): Endoscopic vacuum therapy for treatment of rectal stump leakage. In: Surgical Endoscopy and Other Interventional Techniques, Bd. 35, Nr. 4: S. 1749-1754

Abstract

Background: Symptomatic rectal stump leakage (RSL) is a serious complication after discontinuity resection and requires immediate surgical, interventional, or endoscopic therapy. Re-operations are associated with high morbidity and mortality in these mostly very ill patients. Endoscopic vacuum therapy (EVT) has been established for management of anastomotic leakage;however, its effectiveness for RSL treatment has not been analyzed in detail yet. Methods: A retrospective analysis of patients treated with EVT for RSL between 2001 and 2018 analyzing factors predicting therapy success and duration was carried out. Results: Fifty-six patients with RSL at a median age of 66 years were included. Of these, 18 patients (32%) had been referred for EVT from external departments or institutions. RSL was associated with a relevant clinical deterioration in all patients, and 55 patients (98%) had been classified as ASA 3 and 4, preoperatively. In 9 patients (16%), additional surgical revision was necessary with initiation of EVT. In 47 patients (84%), EVT was successful and local control of the inflammatory focus was achieved. The median duration of therapy was 20 days. Two patients (4%) suffered from minor EVT-associated bleeding that was endoscopically controlled. Preoperative radiation of the pelvis was significantly associated with EVT failure (P = 0.035), whereas patient age represented a predictive factor for therapy length (P = 0.039). In 12 patients (21%), restoration of intestinal continuity was achieved in the further course. Conclusions: We present the first specific series on EVT for RSL. EVT for RSL was shown to be an effective and safe minimal-invasive treatment option, avoiding surgical revision in the majority of patients.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0930-2794
• Sprache: Englisch