Document Detail


Endoscopic transanal vacuum-assisted rectal drainage (ETVARD): an optimized therapy for major leaks from extraperitoneal rectal anastomoses.
MedLine Citation:
PMID:  18189215     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND STUDY AIMS: A major leak from a rectal anastomosis is an important surgical complication. Endoscopic transanal vacuum-assisted rectal drainage (ETVARD) is a new method for treating nonseptic major anastomotic leaks after extraperitoneal rectal anastomoses. PATIENTS AND METHODS: Between January 2002 and March 2007 a total of 17 patients (mean age 61.2 years) who developed anastomotic leakage after resection of the rectum or rectosigmoid colon were prospectively evaluated. Their treatment began with endoscopic debridement of the leak/cavity; nylon sponges were then endoscopically fitted into the cavity. Continuous suction was applied via suction tubes inserted into the sponges. Repeat endoscopies and sponge exchanges, including further debridement were essential. RESULTS: In 16/17 patients ETVARD was successful, relieving patients quickly from infectious symptoms and other complaints; one patient eventually required a Hartmann's procedure. Cavity sizes varied from 2 cm x 2 cm to 10 cm x 13 cm. The mean duration of drainage was 21.4 days, with a mean of 5.4 sponge exchanges and 10.7 endoscopies, and a mean total time to closure of the cavity of 53.1 days. The total time to closure of the cavity was directly dependent on the size of the cavity ( P< 0.015). Fifteen patients received additional intramural fibrin glue injections. In eight patients ETVARD was continued on an outpatient basis. There was no advantage demonstrated for patients with diverting loop ileostomies. Patients with anastomoses that were 6 cm or less from the anocutaneous line had considerably longer healing times. The healing time depended significantly on age ( P< 0.036). Follow-up endoscopies have shown only minor anastomotic changes in two patients. CONCLUSIONS: ETVARD is a well-tolerated and effective therapeutic option for the treatment of major leaks after extraperitoneal rectal anastomoses. In most cases ETVARD obviates the need for additional surgery, in particular diverting loop ileostomy.
Authors:
A Glitsch; W von Bernstorff; U Seltrecht; I Partecke; H Paul; C D Heidecke
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Publication Detail:
Type:  Journal Article     Date:  2008-01-14
Journal Detail:
Title:  Endoscopy     Volume:  40     ISSN:  1438-8812     ISO Abbreviation:  Endoscopy     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-06     Completed Date:  2008-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  192-9     Citation Subset:  IM    
Affiliation:
Department of General Surgery, Visceral, Thoracic and Vascular Surgery, University Hospital, Ernst-Moritz-Arndt-Universität, Greifswald, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical / adverse effects
Colectomy / adverse effects*
Colorectal Neoplasms / pathology,  surgery*
Endoscopy*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prospective Studies
Rectum / surgery*
Suction / methods*
Treatment Outcome
Vacuum

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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