The "impossible" rectal anastomosis: a novel use for endoluminal vacuum-assisted therapy.

Techniques in Coloproctology
Nadja C Lehwald-TywuschikWolfram Trudo Knoefel

Abstract

Low rectal anastomoses can safely be performed, usually secured by a diverting ostomy. However, in cases of inflammation, extensive scarring, after extensive radiation, or after severe stapler dysfunction the risk for an anastomotic leak may become prohibitively high. We present a novel use for endoluminal vacuum-assisted therapy (EVAT) for otherwise "impossible" low rectal anastomoses. Our initial series consisted of 14 consecutive patients who underwent prophylactic EVAT treatment due to unsafe low colorectal anastomosis. The vacuum sponge was placed intraoperatively in cases otherwise calling for a Hartmann's procedure. An open-pored polyurethane sponge was placed prophylactically transanally for a mean duration of 11 days. Patient characteristics, complications, and risk factors were prospectively collected from medical records and analyzed. Between March 2017 and September 2019, we performed this novel technique in 14 patients enabling us to perform an anastomosis. Our collective consisted of 4 female (29%) and 10 male (71%) patients with a medium age of 59 years. Underlying disease was colorectal cancer in 10 patients, ovarian cancer, perforated sigmoid diverticulitis, ischemic colitis and sarcoma in one patient each. Dom...Continue Reading

References

Mar 31, 2010·Techniques in Coloproctology·A ArezzoM Morino
Jan 8, 2015·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·Alberto ArezzoMario Morino
Jul 6, 2019·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·G I PopivanovM S Tabakov

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Methods Mentioned

BETA
sedation

Software Mentioned

EVAT
Excel®
MS
Excel
file

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