title: Early reconstruction of the leaking ileal pouch-anal anastomosis: a novel solution to an old problem.
abstract: OBJECTIVE
  The study aimed to determine the effectiveness and direct medical costs of early surgical closure of the anastomotic defect after a short course of Endo-sponge® therapy of the presacral cavity, compared with conventional treatment in patients with anastomotic leakage after ileal pouch-anal anastomosis (IPAA).
  
  
  METHODS
  Patients with anastomotic leakage after IPAA undergoing early surgical closure of the anastomotic defect after a short Endo-sponge® treatment were prospectively followed and compared with a consecutive cohort of patients with an anastomotic leak treated by creation of a loop ileostomy and occasional drainage of the presacral cavity.
  
  
  RESULTS
  A total of 15 patients were treated with early surgical closure and 29 were treated conventionally. In the early surgical closure group, the Endo-sponge® treatment was continued for a median of 12 days [interquartile range (IQR) 7-15 days] with a median of 3 (IQR 2-4) Endo-sponge® changes. Secondary anastomotic healing was achieved in all patients (n = 15) in the early surgical closure group compared with 52% (n = 16) in the conventional treatment group (P = 0.003). Closure of the anastomotic defect was achieved after a median of 48 (25-103) days in the early surgical closure group compared with 70 (IQR 49-175) days in the conventional treatment group (P = 0.013). A functional pouch was seen in 93% and 86% of the patients in each group. There was no significant difference in direct medical cost.
  
  
  CONCLUSIONS
  Early surgical closure after a short period of Endo-sponge® treatment is highly effective in treating anastomotic leakage after IPAA without increasing cost.
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: T J
authors.initials: TJ
authors.lastname: Gardenbroek
authors.forename: G D
authors.initials: GD
authors.lastname: Musters
authors.forename: C J
authors.initials: CJ
authors.lastname: Buskens
authors.forename: C Y
authors.initials: CY
authors.lastname: Ponsioen
authors.forename: G R A M
authors.initials: GR
authors.lastname: D'Haens
authors.forename: M G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: P J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000601:surgery*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult
keywords: Endo-sponge®; Ileal pouch-anal anastomosis; anastomotic leakage; inflammatory bowel disease; vacuum assisted therapy