Management of colorectal anastomotic leakage using endoscopic negative pressure therapy with or without protective ostomy: a retrospective study

Flavius Şandra-Petrescu,Emmanouil Tzatzarakis,Christoph Reissfelder,Georg Kähler,Florian Herrle

doi:10.1007/s00384-021-04011-8

Abstract

PurposeManagement of colorectal anastomotic leakage (AL) is patient-oriented and requires an interdisciplinary approach. We analyzed the management of AL according to its severity and presence of ostomy and proposed a therapy algorithm.MethodsWe identified all patients who underwent colorectal surgery and developed an AL in our clinic between 2012 and 2017. The management of AL was retrospectively analyzed according to the severity grade: asymptomatic (A), requesting interventional or antibiotic therapy (B), undergoing re-operation (C). The groups were compared according to the leakage characteristics, presence of ostomy, and patient clinical conditions.ResultsWe identified 784 consecutive patients meeting the inclusion criteria. Of these, 10.8% experienced an AL (A = 18%, B = 48%, and C = 34%). The rate of successful ostomy closure was 100% (A), 68% (B), and 62% (C), respectively. Within group B, 91% of the patients were treated solely by endoscopic negative pressure therapy (ENPT), whereas 37% of the patients within group C required ENPT in addition to surgery. Seven cases within group B (17%) required no protective ostomy (nOB) during ENPT which was itself shorter and required less cycles in comparison to group B with ostomy (OB) (p = 0.017 and 0.111, respectively). Moreover, the leakage distance to anal verge was higher in the OB subgroup (p < 0.001).ConclusionENPT for the treatment of colorectal AL is efficient in combination with operative revision or protective ostomy. In selected patients, it is feasible also in the absence of a protective ostomy.

Highlights

Anastomotic leakage (AL) represents a major complication in patients undergoing colorectal surgery since it correlates with high rates of short- and long-term morbidity, as well as with increased health care costs
Endoscopic control was often preferred to computed tomography (CT), as it provides a means of direct evaluation of the anastomosis
We identified 784 patients who underwent colorectal surgery with rectal anastomosis between 1 January 2012 and 31 December 2017 (Table 1)

Summary

Introduction

Anastomotic leakage (AL) represents a major complication in patients undergoing colorectal surgery since it correlates with high rates of short- and long-term morbidity, as well as with increased health care costs. Specific conditions such as the presence of a protective ostomy, blood perfusion at the anastomotic site, or leak characteristics influence AL management. AL management is heterogeneous, patient-oriented, and difficult to standardize. It involves non-operative as well as operative approaches or a combination of both. The former include abscess drainage, stenting or application of sealants, endoscopic negative pressure therapy (ENPT), and irrigation of the leakage cavity. The latter include anastomotic revision or redo, Hartmann’s

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