title: Endo-sponge therapy for management of anastomotic leakages after colorectal surgery: A case series and review of literature.
abstract: BACKGROUND
  Endo-sponge treatment is a novel approach to manage selected patients with anastomotic leakage following colorectal surgery. However, the available data are still scanty.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of the endo-sponge therapy in a large series, and to perform a review of the current evidence concerning such a treatment.
  
  
  METHODS
  Consecutive patients diagnosed with partial colonic anastomotic leakage managed with endo-sponge placement were enrolled. The endo-sponge system was changed every 48-72 h as outpatient, until to cavity closure. Literature review was performed for pooled-data analysis.
  
  
  RESULTS
  Twenty-five patients were enrolled, including 13 (52%) with diverting ileostomy. Following endo-sponge applications (median sessions: 9, range: 1-39; median treatment duration: 4 weeks, range: 1-32), a complete healing was achieved in 22 (88%) patients. Three (12%) patients developed a major complication (1 uretheric fistula, 1 ileal fistula, and 1 pararectal abscess), all successfully treated by surgery. Ileostomy closure was achieved in 11 (84.6%) patients. No mortality related to the procedure was observed. Overall, 174 patients treated with endo-sponge were reported in literature. By considering data of the larger 7 studies, a complete healing of presacral cavity was achieved in 131 (94.3%) out of 149 patients.
  
  
  CONCLUSIONS
  Our relatively large series of patients confirmed the efficacy, tolerability, and an acceptably low complication rate of endo-sponge therapy for colorectal anastomosis leakage treatment.
authors.affiliation: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Strangio
authors.affiliation: Gastronterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy. Electronic address: angelozullo66@yahoo.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.affiliation: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Elisa Chiara
authors.initials: EC
authors.lastname: Ferrara
authors.affiliation: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Anderloni
authors.affiliation: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Carlino
authors.affiliation: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Manol
authors.initials: M
authors.lastname: Jovani
authors.affiliation: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Ciscato
authors.affiliation: Gastronterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000628:therapy*; D003106:Colon / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D015503:Surgical Sponges; D016896:Treatment Outcome
keywords: Anastomotic leakage; Colon surgery; Endo-sponge; Endoscopic treatment