title: Endoscopic Vacuum Therapy in Colorectal Surgery.
abstract: BACKGROUND
  Endoscopic vacuum therapy (EVT) has been established in Germany for the treatment of anastomotic leakage after rectal resection. Continuous or intermittent suction and drainage decrease bacterial contamination, secretion, and local edema promoting perfusion and granulation at the same time. However, data for use and long-term results of EVT in colorectal surgery are still scarce and are often limited by short-term follow-up.
  
  
  OBJECTIVE
  Here, we aimed at analyzing the treatment spectrum and long-term outcome of EVT for defects of the lower gastrointestinal tract.
  
  
  METHODS
  This is a retrospective single-center analysis of EVT for defects of the lower gastrointestinal tract of different etiology in 41 patients over a time period of 8 years (2007-2015) with a mean follow-up of 36 (2-89) months.
  
  
  RESULTS
  In total, 426 polyurethane sponges were placed in lower GI defects of 41 patients (31 male, 10 female) with a median age of 70 years (range, 29-91). Most frequent indications for EVT were anastomotic leakage after rectal resection (n = 20), Hartmann's stump insufficiency (n = 12), and rectal perforation (n = 3). The median number of sponge insertions was six (range, 1-37) with a mean changing interval of 3 days (range, 1-5). Median time of therapy was 20 days. A successful vacuum therapy with local control of the septic focus was achieved in 18 of 20 patients (90 %) with anastomotic leakage after rectal resection and in nine of 12 patients with a Hartmann's stump insufficiency. In 15 of 19 (79 %) patients with a diverting stoma, take-down after successful treatment was possible. Median time to closure was 244 days (range, 152-488 days).
  
  
  CONCLUSIONS
  To our knowledge, this retrospective observation of EVT application for rectal lesions represents the largest patient series in literature. EVT has earned its indication in complication management after colorectal surgery and can achieve a successful control of a local septic focus in the majority of patients.
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany. florian.kuehn@med.uni-rostock.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Kuehn
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Janisch
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwandner
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Alsfasser
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.|Protestant Hospital Lippstadt, Wiedenbrücker Str. 33, 59555, Lippstadt, Germany.
authors.forename: Leif
authors.initials: L
authors.lastname: Schiffmann
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gock
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Klar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D005858:Germany; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D012002:Rectal Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Anastomotic leakage; Colorectal; EVT; Hartmann stump insufficiency