Detection Of Anastomotic Leakage Research Articles

Routine Upper Gastrointestinal Series Post-bariatric Surgery: Predictors, Usage, and Utility.

To investigate usage and utility of routine upper gastrointestinal (UGI) series in the immediate post-operative period to evaluate for leak and other complications. Single institution IRB-approved retrospective review of patients who underwent bariatric procedure between 01/08 and 12/12 with at least 6-month follow-up. Out of 135 patients (23%) who underwent routine UGI imaging, 32% of patients were post-gastric bypass (127) versus 4% of sleeve gastrectomy (8). In patients post-gastric bypass, 22 were found with delayed contrast passage, 3 possible obstruction, 4 possible leak, and only 1 definite leak. In patients post-sleeve gastrectomy, 2 had delayed passage of contrast without evidence of a leak. No leak was identified in 443 patients (77%) who did not undergo imaging. The sensitivity and specificity of UGI series for the detection of leak in gastric bypass patients were 100% and 97%, respectively, and the positive and negative predictive values were 20% and 100%, respectively. On univariate and multivariate analysis, sleeve gastrectomy patients (OR 0.4 sleeve vs bypass; P < 0.01) and male patients (OR 0.4M vs F; P 0.02) were less likely to undergo routine UGI series (OR 0.4M vs F; P 0.02). Routine UGI series may be of limited value for the detection of anastomotic leaks after gastric bypass or sleeve gastrectomy and patients should undergo routine imaging based on clinical parameters. Gastric bypass procedure and female gender were factors increasing the likelihood of routine post-operative UGI. Further larger scale analysis of this important topic is warranted.

Predictive factors and diagnostic significance of CT findings for anastomotic leak after gastric cancer surgery: A retrospective analysis

AbstractBackgroundAnastomotic leak following radical gastrectomy poses a significant risk to patients. Despite previous studies, effective methods for diagnosing anastomotic leaks after gastric cancer surgery remain elusive. In this study, we aimed to assess the overall burden of anastomotic leaks and investigate diagnostic factors, particularly radiological signs on postoperative computed tomography (CT), that may facilitate early detection.MethodsWe included a total of 70 gastric cancer patients who underwent curative gastrectomy and underwent CT examination post‐surgery. Among them, 35 patients with anastomotic leak were matched with 35 patients without anastomotic leak. We compared the rates of various types of postoperative complications between the two groups and conducted univariate and multivariate analyses to identify predictive variables for postoperative diagnosis.ResultsPatients with anastomotic leaks experienced significantly longer postoperative hospital stays and higher overall expenditures (p &lt; 0.001). Logistic regression analysis revealed that extraluminal gas at the anastomosis site, fever (T ≥ 38.5°C), and neutrophilia (NE ≥ 78%) on postoperative days 4–7 were independent diagnostic factors for anastomotic leaks (p &lt; 0.05).ConclusionsThe diagnostic factors identified in this study offer valuable insights into early detection of anastomotic leaks. We recommend early CT examination for patients exhibiting consistent fever and neutrophilia between postoperative days 4 and 7 following gastric cancer surgery.

Continuous pH monitoring using a sensor for the early detection of anastomotic leaks.

Anastomotic leaks (AL) and staple line leaks are a serious post-operative complication that can develop following bariatric surgery. The delay in the onset of symptoms following a leak usually results in reactive diagnostics and treatment, leading to increased patient morbidity and mortality, and a clinical and economic burden on both the patient and the hospital. Despite support in literature for pH as a biomarker for early detection of AL, the current methods of pH detection require significant clinician involvement and resources. Presented here is a polyaniline (PANI)-based pH sensor that can be connected inline to surgical drains to continuously monitor peritoneal secretion in real time for homeostatic changes in pH. During this study, the baseline peritoneal fluid pH was measured in two pigs using the PANI sensor and verified using a benchtop pH probe. The PANI sensor was then utilized to continuously monitor the changes in the pH of peritoneal effluent, as a gastric leak was simulated. The inline sensors were able to detect the resulting local changes in drainage pH within 10 min of leak induction. The successful implementation of this sensor in clinical practice can both enable high efficiency continuous monitoring of patient status and drastically decrease the time required to detect AL, thus potentially decreasing the clinical and economic burden incurred by gastric leaks.

Efficacy of air leak test in detection of anastomotic leaks after rectal excision: a retrospective case-controlled study.

Although its efficacy is uncertain, an intraoperative air leak test (ALT) is commonly used to detect mechanical defects following bowel anastomosis. This study aimed to evaluate the efficacy of ALT to detect anastomotic leakage (AL) following rectal excision. We reviewed our database for patients with rectal cancers who had undergone curative surgery between January 2012 and January 2018. Patients were grouped according to whether or not an ALT was performed. Propensity score analyses were performed to compare outcomes for groups in a 1:1 case-matched cohort. In total, 1,191 patients underwent rectal excision; 438 (219 in each group) formed the case-matched cohort for analysis. The protective stoma rate was 16.0% and 14.6% in the ALT and the no-ALT groups, respectively (P = 0.791). In the ALT group, 2 patients (0.9%) showed a positive result and were treated with rectal tube drainage, resulting in no leakage. There was no significant difference in postoperative AL rate between the groups (ALT group: 4.6% vs. no-ALT group: 4.1%, P > 0.999). ALT played a minimal role in detecting AL following rectal excision. Further studies are warranted to validate our results and clarify whether AL can be prevented with ALT or alternative methods.

Early detection of anastomotic leak with C-reactive protein increases the chances of anastomotic salvage.

Anastomotic leak results in increased morbidity and affects functional and oncological outcomes after colectomy. Measurement of C-reactive protein (CRP) allows early detection of anastomotic leaks. The aim of this study was to evaluate the benefit to the patient of earlier diagnosis and management of anastomotic leaks, namely avoiding takedown of the anastomosis. Patients with an anastomotic fistula after elective colorectal surgery from 2010 to 2020 were included. Three periods were defined according to progressive adherence to the CRP protocol in our department. A comparison was made between the periods 'before' (2010-2013) and 'after' (2016-2020) in terms of morbidity, mortality, anastomotic salvage, days spent in hospital within the first postoperative month, timely adjuvant chemotherapy and anastomotic stenosis. Out of 2655 elective colorectal operations, 171 patients presented with an anastomotic leak and 123 patients were included in the study. In univariate analysis, patients in the 'after' group had fewer severe complications (Clavien-Dindo Grade III to IV, 66.7% vs. 56.9; p= 0.017); the difference did not reach significance regarding timely postoperative chemotherapy (p= 0.058) and anastomotic stenosis (p= 0.682). In both, univariate and multivariate analysis, the 'after' period increased the chances of preserving the anastomosis (OR=2.37 [1.08-5.17]) and increased the number of days out of hospital (p= 0.0002). A CRP-based protocol for the screening of anastomotic leaks after colorectal surgery was related to increased anastomotic conservation, a decreased impact and severity of the leak and a shorter length of hospital stay.

C-reactive protein identifies patients at low risk of anastomotic leak after esophagectomy.

Fast-track protocols are increasingly used after digestive surgery. After esophagectomy, the gravity and the fear of anastomotic leak may be an obstacle to generalization of such protocols. C-reactive protein (CRP) might be a reliable tool to identify patients at low risk of anastomotic leak after esophagectomy, so that they can be safely included in a fast-track program. The aim of our retrospective bicentric study is to evaluate the interest of C-reactive protein measurement for the early diagnosis of anastomotic leak after esophagectomy. Patients having undergone Ivor-Lewis procedure between January 2009 and September 2017 were included in this bicentric retrospective study. CRP values were recorded between postoperative day 3 (POD 3) and postoperative day 5 (POD 5). All postoperative complications were recorded, and the primary endpoint was anastomotic leak. We included 585 patients. Among them, 241 (41.2%) developed infectious complications and 69 patients (11.8%) developed anastomotic leak. CRP had the best predictive value on POD 5 (AUC = 0.74; 95% CI: 0.67-0.81). On POD 5, a cut-off value of 130mg/L yielded a sensitivity of 87%, a specificity of 51%, and a negative predictive value of 96% for the detection of anastomotic leak. CRP may help in identifying patients at very low risk of anastomotic leak after esophagectomy. Patients with CRP values < 130mg/L on POD 5 can safely undertake an enhanced recovery protocol.

C-reactive protein: A predictor for early discharge following colorectal surgery

Objectives: Anastomotic leak following colorectal surgery is a common complication. Late diagnosis following oncological resections can lead to poorer long-term outcomes due to delays in accessing further treatment. A useful biomarker which has been identified in early detection of anastomotic leak is serum C-reactive protein (CRP). A recent meta-analysis confirmed the value of using CRP trajectory to accurately rule out an anastomotic leak after colorectal resection. The aim of this study was to establish a post-operative CRP cut-off value above which the development of anastomotic leak is more likely and to thereby facilitate earlier discharge.

A164 The Role of Intraoperative Drain Placement and Postoperative Imaging in Detection of Anastomotic Leak after Laparoscopic Sleeve Gastrectomy

A164 The Role of Intraoperative Drain Placement and Postoperative Imaging in Detection of Anastomotic Leak after Laparoscopic Sleeve Gastrectomy

Comparison of pleural drain amylase and serum C-reactive protein for early detection of intrathoracic esophago-gastric anastomotic leaks

IntroductionEarly detection of anastomotic leaks following esophagectomy has the potential to reduce hospital length of stay and mortality. The aim of this study was to compare the predictive value of pleural drain amylase and serum C-reactive protein for the early diagnosis of leak.MethodsA retrospective observational cohort study was conducted on 121 patients who underwent Ivor Lewis esophagectomy and intrathoracic gastric conduit reconstruction. Pleural drain amylase levels were measured daily until postoperative day (POD) 5 and compared with CRP values measured on POD 3, 5, and 7. Specificity and sensitivity for both tests, and the respective ROC curves, were calculated.ResultsAnastomotic leak occurred in 12 patients. There was a significant statistical association between pleural drain amylase and serum CRP levels and the presence of anastomotic leakage. Pleural drain amylase cutoff of 209 IU/L on POD 2 yielded a sensitivity of 75% and a specificity of 94% (AUC = 0.813), whereas CRP cutoff value of 22.5 mg/dL on POD 3 yielded a sensitivity of 56% and a specificity of 92% (AUC = 0.772). The negative likelihood ratio of pleural drain amylase was 0.27 and 0.12 on POD 2 and 5, respectively. There was no statistically significant difference between ROC curves of amylase and CRP on POD 3 and 5 (p = 0.79 and p = 0.14, respectively).ConclusionsPleural drain amylase seems more efficient than serum CRP for early detection of esophago-gastric anastomotic leak. The practice of monitoring drain amylase and CRP may allow safer implementation of enhanced postoperative recovery pathway.

Detection of Anastomotic Leakage Following Elective Colonic Surgery: Results of the Prospective Biomarkers and Anastomotic Leakage (BALL) Study

Anastomotic leakage (AL) is an infrequent but life-threatening surgical complication following colorectal surgery. Early diagnosis remains clinically difficult but is a necessity to reduce associated morbidity and mortality. Clinical review and radiological modalities for the diagnosis of leakage remain non-specific and often only detect AL once it is well developed. Inflammatory biomarkers however have shown promise in early pre-clinical detection of leakage following colorectal surgery. A multi-center, prospective observational study was conducted across four public hospitals in Auckland and Christchurch, New Zealand. Consecutive adults undergoing elective colectomy were initially recruited over a 3-y period. Perioperative blood samples were collected to measure interleukin (IL)-6, IL-1β, tumor necrosis factor α, IL-10, C-reactive protein (CRP), leukocyte and neutrophil counts. Statistical analysis was performed to compare patients with an uncomplicated recovery with patients with AL. Sixteen patients developed AL (5.7%), diagnosed at a median post-operative (POD) day 7. CRP and IL-6 were consistently elevated in the early post-operative period in patients with AL, and had the best diagnostic accuracy on POD 3 (area under the curve 0.70; P=0.02) and POD 1 (area under the curve 0.69; P=0.02), respectively. IL-10, once adjusted for body mass index and surgical approach, was the sole biomarker significantly elevated in patients with AL on POD4. Early post-operative elevations of CRP and IL-6 provide utility for early detection of AL after elective colectomy. Application of these inflammatory biomarkers and their combinations in daily practice warrants further investigation.

Predictive value of postoperative serum prealbumin levels for early detection of anastomotic leak after esophagectomy: A retrospective study.

The impact of serum prealbumin in patients with esophageal carcinoma after undergoing esophagectomy remains unclear, we speculated that serum prealbumin is associated with anastomotic leak (AL) after surgery, low serum prealbumin level may lead to AL. The aim of the study was to evaluate the relationship between serum prealbumin levels and AL after esophagectomy, to explore the value of serum prealbumin as an early predictor of AL after esophagectomy.Between January 2014 and December 2018, 255 patients were enrolled in this study, their basic characteristics and perioperative serum prealbumin levels were retrospectively analyzed. Statistical analysis by t test, nonparametric test and logistic regression were used to analyze data for patients with and without AL. Based on a receiver operator characteristic curve, a cut-off value for serum prealbumin levels as a predictor of AL was determined.Among the 255 patients, 18 patients were diagnosed with AL. The overall AL rate was 7.0% (18/255) including 12 cases of intrathoracic AL and 6 cases of cervical AL. By univariate analysis, we identified postoperative serum prealbumin level as a risk factor for AL (P < .001). Multivariate analysis also demonstrated postoperative serum prealbumin level (P = .028) to be an independent risk factor for AL. The best cut-off value of postoperative serum prealbumin level was 131 mg/L for predicting AL, with 83.3% sensitivity and 72.2% specificity.Postoperative serum prealbumin level was significantly associated with AL. it may help the early prediction of postoperative AL.

Comparison of self-expanding metal stent results in esophagogastrostomy and esophagojejunostomy anastomotic leak: a three-center retrospective analysis

Purpose: Our aim was to compare the efficacy and complications of self-expanding metal stents (SEMS) in anastomotic leaks related to esophagogastrostomy (EG) and esophagojejunostomy (EJ). Methods: Demographic characteristics, types of surgery, anastomotic leak detection time, clinical findings, diagnostic methods, radiological and endoscopic findings, biochemical findings, efficacy and complications of SEMS, morbidity, and mortality rates of 17 patients who underwent SEMS due to EG (8 cases) or EJ (9 cases) anastomotic leakage after esophageal and gastric tumor resection between 2013-2019 were compared. Mann-Whitney U test was used in the analysis of quantitative variables, Fisher Exact and Fisher-Freeman-Holton tests were used in the analysis of categorical variables. Results: While early term SEMS migration was not observed in the EG group, it was observed in 5 (55.5%) cases in the EJ group (p=0.564). In the EJ group, laceration in the jejunal loop due to SEMS migration was observed in 1 (11.1%) case, and intestinal perforation was observed in 1 (11.1%) case. The amount of anastomotic leakage after SEMS was significantly decreased in the EG group compared to the EJ group (p=0.028). C-reactive protein values were lower and albumin levels were higher in the EG group compared to EJ group (p=0.093, p=0.078, respectively). Mortality was seen in 1 (12.5%) patient in the EG group and in 5 (55.5%) patients in the EJ group (p=0.131). The mean age of those who developed mortality was higher than those who did not (p=0.015). Conclusion: While SEMS is effective in EG anastomotic leakage, its success rate is low in EJ anastomotic leakage.

Letter to: Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: A prospective cohort study.

Letter to: Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: A prospective cohort study.

1586 Systematic Review and Meta-analysis of Randomised Controlled Trials of Intra-operative Surgical Drainage in Oesophagectomy

Abstract Aim Three surgical approaches to oesophagus have been described. Drain placement in oesophagectomy remains controversial and is associated with complications. The review evaluates the effectiveness of surgically placed drain after oesophagectomy. Method Main electronic databases were searched for studies reported clinical outcomes or effects of cervical (neck), transthoracic (chest) and transabdominal drain placement. The systematic review was conducted according to PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models. Results There were only two randomised controlled trials to date. Neither of these approaches (drain versus no drain) has convincing benefits in any particular oesophagectomy approach in early detection of anastomotic leakage, pleural effusion, and chylothorax nor disadvantages associated with significant morbidity and mortality and prolonged hospital stay. Conclusions Surgical drain in oesophagectomy may not confer additional benefit and routine practice of placement is surgeons preferential. The results do not reach statistical significance. Further work is required.

Drain Amylase: A Simple and Versatile Method of Detecting Esophageal Anastomotic Leaks

BackgroundAnastomotic leak after esophagectomy is a significant cause of morbidity. Perianastomotic drain amylase is accurate in detecting leaks, but it is unclear whether its accuracy is affected by comorbid conditions, anastomotic method, or anastomotic location. We hypothesized that drain amylase would accurately discriminate leak in a variety of settings. MethodsWe reviewed 290 consecutive patients undergoing esophagectomy with gastric conduit reconstruction. Patient comorbidities, operative variables, and drain amylase were collected. The diagnosis of a leak was based on the level of intervention required, and was characterized as clinically significant if it required wound opening or endoscopic or surgical intervention. Receiver-operating characteristic curves analysis was performed to determine the accuracy of amylase to detect leak for each patient variable. ResultsA total of 53 (18.3%) of 290 esophagectomies had an anastomotic leak, of which 33 (11.4%) of 290 were clinically significant. Drain amylase was a strong predictor of anastomotic leak on postoperative day (POD) 3 to POD 7, regardless of patient comorbidities, location of anastomosis, or technique of anastomosis, but was less accurate in the diagnosis of leak in current smokers (area under the receiver-operating characteristic curve, 0.530 vs 0.752; P = .006). A maximum drain amylase value no higher than 35 on POD 3, POD 4, or POD 5 was 88% sensitive in detecting leak at any point postoperatively. A value greater than or equal to 150 was 88% specific in diagnosing leak. ConclusionsDrain amylase is a versatile method for early detection of anastomotic leaks. Its accuracy is unaffected by neoadjuvant treatment, location or type of anastomosis, or patient comorbidities but may be less accurate in active smokers.

An umbrella systematic review of drain fluid analysis in colorectal surgery for the detection of anastomotic leak: Not yet ready to translate research studies into clinical practice.

Anastomotic leak (AL) is the most important complication of intestinal surgery with an anastomosis. Whilst a number of studies have defined risk factors for AL, frustratingly, low-risk patients still develop AL. Studies have looked at drain fluid analysis for detection of AL, but these findings have failed to translate into routine clinical practice. This umbrella systematic review aims to provide an overview of the promising candidate biomarkers (BMs) that show potential to translate into clinical practice. A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane, KSR Evidence and the Epistemonikos databases on the 14 April 2021. Only systematic reviews of cohort or controlled studies measuring drain fluid biomarkers in humans were included. The methodological quality of the reviews was assessed using the AMSTAR 2 instrument. Clinical trial registries were searched for trials actively investigating drain fluid BMs. Candidate BMs were classified, and threshold values investigated. Nine systematic reviews, published between 2007 and 2020, met the inclusion criteria, and contained a total of 36 cohort studies. A total of 38 different BMs were studied. The most promising category of drain fluid BM was the extravasated intra-luminal substances (EILS) and five registered trials of these BMs were found. Two of nine reviews were of moderate quality. The majority of BMs show inconsistent threshold values and are in the experimental stage. A number are not readily available for adoption into routine clinical practice. Most do not state a cut-off value to be considered as diagnostic.

Classification and evaluation of anastomotic leaks after esophageal surgery—a tertiary university experience

Summary Background Anastomotic insufficiency of the esophagus is the most feared complication of surgeons, leading to high postoperative morbidity and mortality. However, there is no internationally accepted guideline for its classification and treatment algorithm. Therefore, the aim of this study was to analyze the detection of anastomotic leaks as well as to discuss and validate the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound in late 2018. Methods All patients undergoing surgery for malignancy of the esophagogastric junction between 2013 and 2020 were analyzed. Out of these patients, those diagnosed with an anastomotic insufficiency were extracted and classified according to the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound. Continuous variables were expressed as medians, categorical variables were compared using Fisher’s exact test or chi-square test. Results From 2013 to 2020, all 23 patients (10.84%) who developed an anastomotic leak after esophageal surgery were included in this study. The study revealed a significant increase in median hospital stay, median intensive care unit stay, and overall mortality rate (p = 0.028) with increased classification type. Conclusion The results of this study showed that the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound can be validated and that there is a clear differentiation between the subtypes. Standardized diagnosis and management improve the overall outcome of patients. Main novel aspects This article gives an introduction to classifying anastomotic insufficiencies according to the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound. Results of the classification can be validated, with a clear differentiation of postoperative outcome between subtypes.

Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study.

Anastomotic leak can adversely affect the outcome of surgery especially if detected late. The present study was carried out to detect the anastomotic leak early in the postoperative period using serial estimation of procalcitonin (PCT) and C-reactive protein (CRP). A single centre prospective cohort study was done on patients undergoing elective gastrointestinal surgery with anastomosis. Serial estimation of serum procalcitonin and C reactive protein was done on the first five postoperative days. Other parameters such as hemoglobin, total protein, albumin and WBC counts were noted perioperatively. Patients were followed up to 60th postoperative day to assess for anastomotic leak, wound infection and other septic foci. Eighty-four patients were included in the study. Anastomotic leak rate was 26.19% (22/84) and 3/22 patients died in the anastomotic leak group. Wound infection rate was 23.81%. The cut off value of CRP on third postoperative day in detecting anastomotic leak was 44.322 mg/dl with sensitivity of 72.73%, specificity of 66.13% and accuracy of 59.52%. The cut off value for WBC count measured perioperatively in detecting anastomotic leak was 9470 cell/mm3 with sensitivity of 72.73%, specificity of 56.45% and accuracy of 59.74%. Serum procalcitonin, haemoglobin, total protein and albumin measured were not sensitive enough to detect the anastomotic leak early. Measuring CRP on the third postoperative day can predict anastomotic leak with a cut off value of 44.32 mg/dl. Patients with raised CRP need careful evaluation to rule out anastomotic leak before deciding on early discharge.

Early detection of anastomotic leakage after esophagectomy using drain amylase levels.

Early diagnosis of anastomotic leakage (AL) after esophagectomy is essential to minimize postoperative complications. In this study, we hypothesized that drain amylase levels may be useful for early AL detection, and measuring drain amylase levels could reduce severe postoperative AL incidence. We, therefore, analyzed the usefulness of measuring drain fluid amylase levels after esophagectomy, in esophageal cancer patients. From January 2016 to March 2020, 134 patients with esophageal cancer who underwent surgical resection with esophagogastric anastomosis in the cervical region were included. The patients were divided into a group whose cervical drain fluid amylase levels were not measured (No-AMY Group) and a group whose cervical drain fluid amylase levels were measured daily until postoperative day (POD) 7 (AMY Group). The incidence of severe AL was compared between groups. In the AMY Group, we also investigated the association between AL and drain amylase levels. Drain amylase levels were significantly higher in AL-positive cases than in AL-negative cases (P < 0.001). Receiver operating characteristic curve analysis revealed the drain amylase level cut-off value for AL diagnosis was 1800 U/L on POD 2 (Area under the curve = 0.835; P = 0.027). The incidence of ≥ grade III AL was significantly lower in the AMY Group than in the No-AMY Group (2 vs. 10%, P = 0.047). Cervical drain fluid amylase levels can be a useful screening method for early detection of AL after esophagectomy for esophageal cancer and may help reduce incidence of severe postoperative AL.

Treatment of Anastomotic Leaks With EndoVac After Low Anterior Resection in Colorectal Cancers.

Endoscopic drainage should preferably be tried unless the abscess caused by the anastomotic leak is generalized and disseminated into the abdominal cavity. The aim of this study was to evaluate the results of patients treated with EndoVac. The medical records of patients who underwent low anterior resection and were treated using the EndoVac therapy system due to the detection of an anastomotic leak were retrospectively evaluated. Thirty-three of the patients with detection of anastomotic leaks were treated using EndoVac therapy system. The mean number of application of the EndoVac therapy system was 5.8 (1 to 12) for each patient. Mean duration of hospitalization of the patients was 24.5 (9 to 92) days. Five patients underwent a second operation during the follow-up period after application of the EndoVac therapy system. In our study, the number of patients recovering without the need for additional treatment is 30 (30/33). Our success rate was 90.1%. The EndoVac therapy system is an alternative and helpful system in the treatment of colorectal anastomotic leaks without reoperation needed. It can also prevent permanent stoma.