Management of Anastomotic Leak after Colorectal Surgery with Vacuum-Assisted Therapy (Endo-SPONGE®) Complemented with Fibrin Glue Sealing

Anastomotic leak is a major complication of colorectal surgery associated with high morbidity and mortality [1, 2]. Endoluminal vacuum-assisted therapy (EVT) is a minimally invasive method for leakage treatment. It facilitates intestinal continuity and improves the function of the neorectum, especially if started within 6 weeks [1– 3]. A 58-year-old male was submitted to anterior resection of the rectum due to a T2-rectal adenocarcinoma. One week later, the patient was admitted to the ER for fever and abdominal pain. Abdominopelvic CT revealed a hydro-aerial collection (68 × 87 mm) adjacent to the rectal suture. Conservative treatment with broad-spectrum antibiotics and CT-guided percutaneous drainage was subsequently performed. Rectosigmoidoscopy allowed the identification of the anastomotic leak reaching half of the rectal perimeter, at 2 cm from the anal verge, communicating with a 9-cm cavity containing purulent exudate and the previously placed pigtail drain (Fig. 1a). EVT with Endo-SPONGE® was attempted 4 weeks after surgery. The procedures were performed in an outpatient setting, with high-definition gastroscopes (Olympus®GIF-H180; Olympus® GIF-H185) every 48–72 h. The length and size of the abscess cavity were measured, and the Endo-SPONGE® was then cut accordingly. After the introduction of the scope into the cavity, an overtube was advanced into the deepest position. The scope was withdrawn, and the EndoSPONGE® was inserted into the cavity using a pushing probe and subsequently connected to a vacuum suction system.