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      Transanal Drainage of Coloanal Anastomotic Leaks

      case-report
      Author(s): 1 , 2 , 2 ,
      Publication date (Electronic):
      Journal: Case Reports in Surgery
      Publisher: Hindawi

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          Abstract

          The conventional operative intervention for leaks following coloanal anastomoses has been proximal fecal diversion with or without take-down of anastomosis. A few of these cases are also amenable to percutaneous drainage. Ostomies created in this situation are often permanent, specifically in cases where coloanal anastomoses are taken down at the time of reoperation. We present two patients who developed perianastomotic pelvic abscesses that were treated with transanal large bore catheter drainage resulting in successful salvage of coloanal anastomoses without the need for a laparotomy or ostomy creation. We propose this to be an effective therapeutic approach to leaks involving low coloanal anastomoses in the absence of generalized peritonitis.

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          Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method.

          Fritz Spelsberg, Klaus Gruetzner, Timm Wiecken … (2008)
          Conservative treatment of anastomotic leakage after anterior resection of the rectum seems to be possible in patients who have no occurrence of generalized peritonitis. This report describes a new method of endoscopic management of large anastomotic leakage in these patients. The main feature of this new method is the endoscopically assisted placement of an open-cell sponge connected to a vacuum device into the abscess cavity via an introducer device. The sponge system is changed every 48-72 h. Twenty-nine patients with an anastomotic leakage after anterior resection were treated with the endoscopic vacuum therapy. The total duration of endovac therapy was 34.4 +/- 19.4 days. The total number of endoscopic sessions per patient was 11.4 +/- 6.3. In 21 of the 29 patients, a protecting stoma was created at the primary operation. Four patients were treated successfully without the need of a secondary stoma. Definitive healing was achieved in 28 of the 29 patients. Endoscopic vacuum-assisted closure is a new efficacious modality for treating anastomotic leakage following anterior resection due to an effective control of the septic focus. Further studies will show if it is possible to reduce the high mortality rate of patients with anastomotic leakage through the avoidance of surgical reinterventions while at the same time preserving the sphincter function.
          Article 0 comments Cited 82 times – based on 0 reviews     Review now
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            Management of low colorectal anastomotic leak: Preserving the anastomosis.

            Jennifer Blumetti, Herand Abcarian (2015)
            Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal anastomotic leak. Currently operative procedures are reserved for patients with frank purulent or feculent peritonitis and unstable vital signs, and vary from simple fecal diversion with drainage to resection of the anastomosis and closure of the rectal stump with end colostomy (Hartmann's procedure). However, if the patient is stable, and the leak is identified days or even weeks postoperatively, less aggressive therapeutic measures may result in healing of the leak and salvage of the anastomosis. Advances in diagnosis and treatment of pelvic collections with percutaneous treatments, and newer methods of endoscopic therapies for the acutely leaking anastomosis, such as use of the endosponge, stents or clips, have greatly reduced the need for surgical intervention in selected cases. Diverting ileostomy, if not already in place, may be considered to reduce fecal contamination. For subclinical leaks or those that persist after the initial surgery, endoluminal approaches such as injection of fibrin sealant, use of endoscopic clips, or transanal closure of the very low anastomosis may be utilized. These newer techniques have variable success rates and must be individualized to the patient, with the goal of treatment being restoration of gastrointestinal continuity and healing of the anastomosis. A review of the treatment of low colorectal anastomotic leaks is presented.
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              Early, minimally invasive closure of anastomotic leaks: a new concept.

              T Verlaan, S Bartels, M. van Berge Henegouwen … (2011)
              Chronic pelvic sepsis after ileoanal or coloanal anastomosis precludes ileostomy closure and, even if closure is ultimately possible, function of the neorectum is badly affected. Early closure of the anastomotic leak might prevent chronic pelvic sepsis and its adverse sequelae. In our experience of early closure in a consecutive group of six patients with a leaking low anastomosis (five with ileoanal pouch anastomosis and one after a low anterior resection), we were able to achieve anastomotic closure in five by means of initial endosponge therapy followed either by early suture (four patients) or endoscopic clip repair (one patient). Early minimally invasive closure of low anastomotic leaks is therefore possible provided that the para-anastomotic cavity is drained well prior to closure and the anastomosis is defunctioned.
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                Author and article information

                Contributors
                Syed Husain:
                ORCID: http://orcid.org/0000-0003-2530-8362
                Journal
                Journal ID (nlm-ta): Case Rep Surg
                Journal ID (iso-abbrev): Case Rep Surg
                Journal ID (publisher-id): CRIS
                Title: Case Reports in Surgery
                Publisher: Hindawi
                ISSN (Print): 2090-6900
                ISSN (Electronic): 2090-6919
                Publication date Collection: 2018
                Publication date (Electronic): 27 March 2018
                Volume: 2018
                Electronic Location Identifier: 9806259
                Affiliations
                1Department of Surgery, OhioHealth Doctors Hospital, 5100 West Broad Street, Columbus, OH 43228, USA
                2Division of Colon and Rectal Surgery, Wexner Medical Center, The Ohio State University, N737 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA
                Author notes

                Academic Editor: Nisar A. Chowdri

                Author information
                http://orcid.org/0000-0003-2530-8362
                Article
                DOI: 10.1155/2018/9806259
                PMC ID: 5896232
                SO-VID: 9b106c35-60bb-4e3f-99e1-e9a835a8efb1
                Copyright © Copyright © 2018 Bradley Sherman et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 September 2017
                Date accepted : 5 March 2018
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Data availability:
                ScienceOpen disciplines: Surgery

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