title: An initial experience using transanal vacuum therapy in pelvic anastomotic leakage.
abstract: BACKGROUND
  Treatment of the presacral cavity that forms after contained anastomotic leakage of a low pelvic anastomosis is challenging and often results in a permanent stoma. Endosponge™ therapy is a minimally invasive method of treating the presacral cavity which potentially avoids a permanent stoma. We report our initial experience of using Endosponge™ therapy.
  
  
  METHODS
  All patients who underwent Endosponge™ treatment for low pelvic anastomotic leakage in our hospital over a 45-month period were identified and data collected from clinical, operative and endoscopic notes.
  
  
  RESULTS
  Eight patients (seven males, one female) underwent Endosponge™ therapy for extraperitoneal pelvic anastomotic leak during the study period; all had had defunctioning ileostomies placed at their original surgery. Six out of eight patients had complete closure or a reduction in the size of the abscess cavity. Five patients have had their ileostomies reversed with good or reasonable bowel function after a median follow-up of 41 months and four of these patients had Endosponge™ therapy instituted within 6 weeks of initial surgery. One patient had Endosponge™ therapy abandoned and conversion to a permanent end colostomy after accidental intraperitoneal placement of the sponge.
  
  
  CONCLUSIONS
  Early use of Endosponge™ therapy appears to offer a minimally invasive and effective way of closing the presacral cavity after a pelvic anastomotic leak, reducing the risk of permanent stoma and resulting in acceptable bowel function. Endosponge™-specific complications can occur.
authors.affiliation: Department of Colorectal Surgery, The Rotherham NHS Foundation Trust, Moorgate Road, Rotherham, South Yorkshire, S60 2UD, UK.
authors.forename: D
authors.initials: D
authors.lastname: Srinivasamurthy
authors.forename: C
authors.initials: C
authors.lastname: Wood
authors.forename: R
authors.initials: R
authors.lastname: Slater
authors.forename: J
authors.initials: J
authors.lastname: Garner
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014618:Vacuum