An Approach to Perianastomotic Pouches due to Anastomotic Leakage After Rectal Resection

Objective: Conservative treatment of perianastomotic pouch due to low anastomosis in rectal surgery is possible in patients without generalized peritonitis. This report describes the treatment of this complication using Endo-SPONGE® and transrectal endoscopic lavage. Methods: Sixteen patients with abscess resulting from anastomotic leakage after rectal resections were retrospectively reviewed; nine of them were treated with transrectal endoscopic lavage and the other seven patients were treated with endoscopic vacuum therapy. Results: During the initial operation, 13 patients underwent loop ileostomy. In three patients, diverting stoma was created after anastomotic leakage was observed. The mean volume of the abscess cavity was 82.6 cc (24.7-128) for those treated with EndoVAC (vacuum-assisted closure) and 33.3 cc (10.5-61.1) for those treated with endoscopic lavage. The number of sponges exchanged was 13.8 (5-25), and the time required for pouch closure was 74.3 days (20-136) for negative aspiration therapy and 66.1 days (30-210) for transrectal endoscopic lavage. As a late anastomotic complication, we recorded stricture in only one of seven patients (14.2%) treated with Endo-SPONGE®. Four of nine patients (44.4%) that underwent endoscopic lavage developed strictures, which needed reoperative procedures. Conclusion: According to our experience, the sponge placement and negative pressure aspiration can be helpful in the treatment of anastomotic leakage after low anterior resections for rectal cancer. The results of time until cavity closure are not inferior to those of the conventional treatment, and a functional advantage over the conventional approach was observed. Patients with Endo-SPONGE® placement had less stricture and defecation problems.