title: Early, minimally invasive closure of anastomotic leaks: a new concept.
abstract: Chronic pelvic sepsis after ileoanal or coloanal anastomosis precludes ileostomy closure and, even if closure is ultimately possible, function of the neorectum is badly affected. Early closure of the anastomotic leak might prevent chronic pelvic sepsis and its adverse sequelae. In our experience of early closure in a consecutive group of six patients with a leaking low anastomosis (five with ileoanal pouch anastomosis and one after a low anterior resection), we were able to achieve anastomotic closure in five by means of initial endosponge therapy followed either by early suture (four patients) or endoscopic clip repair (one patient). Early minimally invasive closure of low anastomotic leaks is therefore possible provided that the para-anastomotic cavity is drained well prior to closure and the anastomosis is defunctioned.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Verlaan
authors.forename: S A L
authors.initials: SA
authors.lastname: Bartels
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.forename: P J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D000038:Abscess / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000601:surgery; D003106:Colon / Q000601:surgery; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D034161:Pelvic Infection / Q000517:prevention & control*; D016737:Proctocolectomy, Restorative; D012004:Rectal Neoplasms / Q000601:surgery; D012812:Sigmoidoscopy / Q000295:instrumentation*; D058106:Wound Closure Techniques