The Dutch multicenter experience of the endo-sponge treatment for anastomotic leakage after colorectal surgery.
BACKGROUND
Anastomotic leakage is a feared complication following colorectal surgery and is associated with early and long-term morbidity and mortality. The presacral cavity as the result of leakage can be treated with an endo-sponge (B-Braun Medical). The aim of this study was to assess the effectiveness of endo-sponge treatment of the presacral cavity as the result of anastomotic leakage in the Netherlands.


METHODS
Between July 2006 and April 2008, 16 patients (M/F = 9:7) with median age 64 years (range 19-78 years) who underwent surgery for rectal cancer (n = 13) or ulcerative colitis (n = 3) were treated with the endo-sponge treatment after anastomotic leakage.


RESULTS
Of the 16 patients, eight patients started with the endo-sponge treatment within 6 weeks after the initial surgery. In these patients the endo-sponge was placed after a median of 24 days (range 13-39 days) following surgery. In the remaining eight patients the endo-sponge treatment was started later than 6 weeks after the initial surgery. In this group there was a median of 74 days (range 43-1,602 days) between surgery and the start of endo-sponge placement. There was closure in six out of eight patients (75%) in the group that started with the endo-sponge treatment within 6 weeks of surgery compared with three out of eight patients (38%) in the group that started later (p = 0.315). Closure was achieved in a median of 40 (range 28-90) days with a median number of 13 sponge replacements (range 8-17).


CONCLUSIONS
Endo-sponge placement can be helpful in the treatment for anastomotic leakage after colorectal surgery and might prevent a chronic presacral sinus. However, it is not yet clear if this new treatment modality results in quicker healing.
van Koperen
P J
PJ
Department of Surgery, Academic Medical Center, P.O. Box 22660, 1100 A2, DD, Amsterdam, The Netherlands. p.j.vankoperen@amc.uva.nl
van Berge Henegouwen
M I
MI
Rosman
C
C
Bakker
C M
CM
Heres
P
P
Slors
J F M
JF
Bemelman
W A
WA
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D015503:Surgical Sponges; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult