Endoluminal negative pressure therapy (Endo-SPONGE) for anastomotic leaks following transanal total mesorectal excision: Our experience

Abstract

Introduction: The management of anastomotic leaks in rectal cancer surgery poses a huge challenge, especially in patients developing a leak post transanal total mesorectal excision (taTME). Endoluminal negative pressure therapy is a minimally invasive method of managing the situation effectively and most times preventing a highly morbid reoperation. Aim: The aim was to study the effectiveness and safety of Endo-SPONGE therapy in the management of anastomotic leaks following taTME. Methods: We looked at our data spanning 4 years of patients developing anastomotic leaks following taTME and their management. The primary outcome measure was complete closure of the anastomotic leak and/or abscess cavity. The secondary outcome measures included the length of stay, stoma closure, and complication rates. Results: Nine patients from our series had anastomotic leak following taTME, four of which had endoluminal negative pressure therapy and were included in the study. These were all male patients and had either T2 or T3 tumor. The median age was 59 years, with a median American Society of Anesthesiologists grade of II and the most common comorbidity being diabetes mellitus (75%). The mean average body mass index of these patients was 25, and the initial (taTME) preoperative P-POSSUM morbidity and mortality median was 49 and 3%, respectively. The median distance of the anastomosis was 4 cm from the external anal sphincter. A median of six Endo-SPONGE was used per patient with a 100% success rate. Low negative pressure was advocated in all cases (80–110 mmHg). The average length of stay was 57 days. The most frequent complication of the Endo-SPONGE was a presacral abscess, followed by stenosis of the anastomosis. There were no mortality in the Endo-SPONGE group and no local recurrence of cancer. Conclusion: Introduced in the early 21st century, endoluminal negative pressure therapy is a viable option to consider for the management of anastomotic leak following low rectal anastomosis in taTME. Our initial experience with Endo-SPONGE is promising and was able to prevent high-risk redo operations or Hartmann's procedures in the select group of patients, thereby not impairing the quality of life significantly.