Seagal Dauglas, MS, IV1, Christopher Melton, MSIII1, Leeds Steven, MD2, Fleshman James, MD2, Walter Peters, MD2, Katerina Wells, MD2. 1Texas A&M Health Sciences, 2Baylor University Medical Center, Dept. of Surgery
Objective of the technology or device: Anastomotic leak is one of the most challenging complications resulting from gastrointestinal surgery, as it is associated with significant patient morbidity and mortality. The anastomoses created following low anterior resections have among the highest associated leak rates with long-term sequelae of poor function or need for fecal diversion. The two main goals of treating anastomotic leaks and perforations are to effectively drain the septic focus and to permanently close the defect allowing for the restoration of intestinal continuity. Vacuum-assisted closure for treatment of external wounds has been successfully used for over 20 years. Endoscopic vacuum-assisted therapy (E-VAC) is an emerging technique used to treat anastomotic leaks as an alternative to the traditional therapies such as catheter drainage and fecal diversion.
Description of the technology and method of its use or application: The E-VAC therapy uses similar principles as the external vacuum assisted closure therapy. Negative pressure is applied to a defect in and intestinal lumen through the use of a silastic tube inserted into a traditional VAC sponge. It is theorized that this approach removes microorganisms from the wound cavity, reduces interstitial edema through improvement of microcirculation, and promotes wound closure through increased granulation and re-epithelialization. We have used this technique to treat anastomotic leaks and perforations to accelerate healing of anastomotic defects and prevent long-term complications.
Preliminary results: Over the study period, 35 patients were retrospectively identified to have undergone E-VAC therapy for the treatment of anastomotic leak or rectal perforation. Thirty-day mortality rate was 0%. Patients underwent a median of 4 treatments (range 3-6 treatments) at an mean interval of 4 days for a mean treatment duration of 15.1 days +/- 11.2 days. A protective ostomy was employed in 91.4% (n=32) patients with 8.6% (n=3) not requiring protective ostomy. Of the patients requiring protective ostomy, 59.4% underwent protective ostomy at the time of index operation and 40.3% required protective ostomy following EVAC therapy initiation. EVAC success, defined as salvaged anastomosis and avoidance of additional intervention during the patient’s hospital stay was 62.9% (n=22). Of those patients who failed EVAC therapy as a primary curative intervention, 45.5% (n=5) still saw long term success at median follow up of 7 mo. (range 3-11 mo.), defined as salvaged anastomosis and/or reversal of ostomy through the application of traditional therapies. Among patients with leaks rising from coloanal anastomoses (n=8), EVAC was successful as a curative intervention in 50% (n=4) patients. Of those who failed EVAC therapy, 50% (n=2) still experienced long-term success. The most common cause of treatment failure for was a persistent leak (n=6).
Conclusions/Future Direction: E-VAC therapy has a high success rate in the treatment of anastomotic leaks and perforations and holds promise as an effective adjunctive therapy. However in order to establish E-VAC therapy as a standard of care, greater experience and further studies in the form randomized clinical trials with long-term follow up are needed to determine the efficacy of this novel technique.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91277
Program Number: ETP887
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster