440

ENDOLUMINAL VACUUM THERAPY FOR POUCH LEAKS AFTER ILEAL POUCH-ANAL ANASTOMOSIS

Date
May 19, 2024

Background: Anastomotic leakage is a dreaded complication after ileal pouch-anal anastomosis (IPAA) that occurs in 5-10% of cases. Endoluminal vacuum (EndoVac) therapy has emerged as a minimally invasive option that promotes healing by applying negative pressure to the associated abscess cavity through the anastomotic defect but is typically applied only to early IPAA leaks. We hypothesized that EndoVac for early compared with late leaks would be associated with a higher pouch survival rate.

Methods: We retrospectively reviewed the medical records of consecutive patients who developed a pouch anastomotic leak after IPAA and were treated with EndoVac therapy at our institution between 2005-2023. Patients were stratified into early (30 days) and late (>30 days) leaks. Anastomotic healing was defined as complete closure of the leak site, as evidenced by resolution of symptoms, normal endoscopic and radiographic evaluation, and no further drainage from the presacral space or abdominal wall. Pouch failure was defined as a permanent ileostomy or pouch excision. Figures represent frequency (proportion) or median (range). The probability of pouch survival over time was estimated using the Kaplan-Meier method.

Results: A total of 14 IPAA patients who underwent EndoVac therapy for anastomotic leaks were identified. The median age was 34 years, 57% were male, and the median body mass index was 23.46 kg/m2. Diagnoses included ulcerative colitis (n=12) and familial adenomatous polyposis (FAP, n=2). The median time from pouch construction to leak was 44.5 (12–192) days; of these, 6 (43%) were early and 8 (57%) were late. All (100%) leaks were at the anal anastomosis site, and all (100%) patients were diverted at the time of EndoVac therapy: 10 (71%) were still diverted and 4 (29%) were re-diverted. Patients underwent a median of 5.5 EndoVac changes (IQR:3-7) over a median duration of 34.5 (21-125) days from initiation of treatment to cessation of therapy. At the end of EndoVac therapy, healing of the leak was observed in 10 (71%) patients, 2 of whom required a minor handsewn revision of the anastomosis; the remaining 4 did not heal and underwent transabdominal surgery: 3 pouch excision and 1 redo pouch surgery. The rates of anastomotic healing (66.7% vs. 75%, p=1.0) and pouch survival (83.3% vs. 75%, p=1.0) were not significantly different between the early and late leak groups. Among those who healed after EndoVac therapy, a total of 8/10 (77.8%) had their diverting loop ileostomy reversed. The overall pouch salvage rate was 78.5%.

Conclusions: EndoVac therapy is effective for postoperative pouch leaks and achieves a high rate of pouch salvage in both early and late leaks.

Tracks

Related Products

Thumbnail for IMPACT OF POUCH LEAKS ON QUALITY OF LIFE AND SYMPTOMS IN PATIENTS AFTER ILEAL POUCH-ANAL ANASTOMOSIS SURGERY
IMPACT OF POUCH LEAKS ON QUALITY OF LIFE AND SYMPTOMS IN PATIENTS AFTER ILEAL POUCH-ANAL ANASTOMOSIS SURGERY
INTRODUCTION: Ileal pouch-anal anastomosis (IPAA) is the procedure of choice in patients requiring total proctocolectomy. The reported leak rates after IPAA surgery range from 1-12% with well described significant impact on postoperative morbidity and recovery…
Thumbnail for DOES MESORECTAL FASCIA INVOLVEMENT (MRF) AFFECT THE RESPONSE TO TNT IN LOCALLY ADVANCED RECTAL CANCERS?
DOES MESORECTAL FASCIA INVOLVEMENT (MRF) AFFECT THE RESPONSE TO TNT IN LOCALLY ADVANCED RECTAL CANCERS?
BACKGROUND: In the treatment of locally advanced rectal cancer (LARC), there has been a paradigm shift towards the routine use of total neoadjuvant treatment (TNT). Despite its growing acceptance, there are limited studies examining factors predictive of response to TNT…
Thumbnail for MESENTERIC LENGTHENING TECHNIQUES FOR ILEOANAL POUCH CONSTRUCTION: WHAT TO DO WHEN THE POUCH WON'T REACH
MESENTERIC LENGTHENING TECHNIQUES FOR ILEOANAL POUCH CONSTRUCTION: WHAT TO DO WHEN THE POUCH WON'T REACH
During ileal pouch-anal anastomosis (IPAA), difficulty in reaching the pelvic floor and excess mesenteric tension on the pouch are technical challenges that surgeons must overcome, and excess tension may be associated with increased anastomotic leak rates…
Thumbnail for MALE GENITOURINARY DYSFUNCTION AFTER MINIMALLY INVASIVE AND OPEN ILEOANAL POUCH
MALE GENITOURINARY DYSFUNCTION AFTER MINIMALLY INVASIVE AND OPEN ILEOANAL POUCH
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for IBD or FAP. As these diseases often manifest during adolescence or early adulthood, treatment effects on genitourinary function (GU), sexual function, and fertility are clinically important…