title: Endoluminal Vacuum Therapy as Treatment for Anastomotic Colorectal Leakage.
abstract: BACKGROUND
  The clinical leakage rate after anterior resection varies from 2.8-20%, with a 6-22% mortality rate and a 10-80% risk of permanent stoma. Endo-SPONGE® (B. Braun Melsungen AG, Melsungen, Germany) may treat extraperitoneal anastomotic leakage in the lesser pelvis. It consists of an open-pored sponge inserted into the cavity. A drainage tube fixed to a low vacuum drainage system is then connected to the sponge through the anus.
  
  
  METHODS
  Between January 2007 and December 2014, 14 patients with anastomotic leakage following low anterior resection were treated with Endo-SPONGE® and were prospectively evaluated. In all patients, a CT-scan was performed and they received an intravenous antibiotic therapy with piperacillin+tazobactam (4.5g,3 times/daily). Complete healing was defined as endoscopically proven closure of the insufficiency cavity with a normal mucosa.
  
  
  RESULTS
  Stapled straight end to end, colorectal anastomoses were performed in all patients between 3-7 cm above the anal verge, a protective loop ileostomy was performed in every patient. The diagnosis of anastomotic leakage was performed after a median interval of 14 days, the median size of the cavity was 81x46 mm. Fluid collection was drained, percutaneosly in 12 cases, surgically in two patients. The median duration of therapy was 35 days, with 3-14 sponge exchanges for each patient. Median healing time was 37 days. No intraoperative complications were recorded, however, we found five cases of mild anal pain treated medically.
  
  
  CONCLUSIONS
  Considering the literature and our results, the Endo-SPONGE® seems an effective, minimally invasive procedure to treat extraperitoneal anastomotic leakage, reducing morbidity, mortality, and hospital stay.
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Milito
authors.affiliation: Department of Surgery, University Hospital of Borgo Roma, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lisi
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Venditti
authors.affiliation: Department of Surgery, University Hospital of Modena, Modena, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Campanelli
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Aronadio
authors.affiliation: Department of Surgery, University Hospital of Messina, Messina, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Grande
authors.affiliation: Department of Surgery, University Hospital of Modena, Modena, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cabry
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Grande
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000601:surgery*; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D015503:Surgical Sponges