Recurrent abscess after primary successful endo-sponge treatment of anastomotic leakage following rectal surgery.
OBJECTIVE
To assess long-term efficacy of initially successful endo-sponge assisted therapy.


METHODS
Between 2006 and 2009, consecutive patients who had undergone primary successful endo-sponge treatment of anastomotic leakage following rectal cancer surgery were enrolled in the study. Patients were recruited from 6 surgical departments in Vienna. Clinical and oncologic outcomes were assessed through routine endoscopic and radiologic follow-up examination.


RESULTS
Twenty patients (7 female, 13 male) were included. The indications for endo-sponge treatment were anastomotic leakage (n = 17) and insufficiency of a rectal stump after Hartmann's procedure (n = 3). All patients were primarily operated for rectal cancer. The overall mortality rate was 25%. The median follow-up duration was 17 mo (range 1.5-29.8 mo). Five patients (25%) developed a recurrent abscess. Median time between last day of endo-sponge therapy and occurrence of recurrent abscess was 255 d (range 21-733 d). One of these patients was treated by computed tomography-guided drainage and in 3 patients Hartmann's procedure had to be performed. Two patients (10%) developed a local tumor recurrence and subsequently died.


CONCLUSIONS
Despite successful primary outcome, patients who receive endo-sponge therapy should be closely monitored in the first 2 years, since recurrence might occur.
Riss
Stefan
S
Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. stefan.riss@meduniwien.ac.at
Stift
Anton
A
Kienbacher
Caroline
C
Dauser
Bernhard
B
Haunold
Ingrid
I
Kriwanek
Stefan
S
Radlsboek
Wolfgang
W
Bergmann
Michael
M
D000038:Abscess / Q000209:etiology* / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D015503:Surgical Sponges; D016896:Treatment Outcome