Brief Article
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World J Gastroenterol. Sep 28, 2010; 16(36): 4570-4574
Published online Sep 28, 2010. doi: 10.3748/wjg.v16.i36.4570
Recurrent abscess after primary successful endo-sponge treatment of anastomotic leakage following rectal surgery
Stefan Riss, Anton Stift, Caroline Kienbacher, Bernhard Dauser, Ingrid Haunold, Stefan Kriwanek, Wolfgang Radlsboek, Michael Bergmann
Stefan Riss, Anton Stift, Michael Bergmann, Division of General Surgery, Department of Surgery, Medical University of Vienna, A-1090 Vienna, Austria
Caroline Kienbacher, Department of Surgery, Floridsdorf Hospital, A-1210 Vienna, Austria
Bernhard Dauser, Department of Surgery, Barmherzige Brüder Wien, A-1020 Vienna, Austria
Ingrid Haunold, Department of Surgery, Barmherzige Schwestern Wien, A-1060 Vienna, Austria
Stefan Kriwanek, Department of Surgery, Rudolfstiftung Hospital, A-1030 Vienna, Austria
Wolfgang Radlsboek, Department of Surgery, Göttlicher Heiland Wien, A-1170 Vienna, Austria
Author contributions: Riss S, Stift A, Kienbacher C, Dauser B, Haunold I, Kriwanek S, Radlsboek W and Bergmann M all contributed to the conception and design of the study, and to acquisition and interpretation of the data; all authors revised the article and approved the final version.
Correspondence to: Stefan Riss, MD, Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. stefan.riss@meduniwien.ac.at
Telephone: +43-1-404005621 Fax: +43-1-404006932
Received: March 30, 2010
Revised: May 18, 2010
Accepted: May 25, 2010
Published online: September 28, 2010
Abstract

AIM: To assess long-term efficacy of initially successful endo-sponge assisted therapy.

METHODS: Between 2006 and 2009, consecutive patients who had undergone primary successful endo-sponge treatment of anastomotic leakage following rectal cancer surgery were enrolled in the study. Patients were recruited from 6 surgical departments in Vienna. Clinical and oncologic outcomes were assessed through routine endoscopic and radiologic follow-up examination.

RESULTS: Twenty patients (7 female, 13 male) were included. The indications for endo-sponge treatment were anastomotic leakage (n = 17) and insufficiency of a rectal stump after Hartmann’s procedure (n = 3). All patients were primarily operated for rectal cancer. The overall mortality rate was 25%. The median follow-up duration was 17 mo (range 1.5-29.8 mo). Five patients (25%) developed a recurrent abscess. Median time between last day of endo-sponge therapy and occurrence of recurrent abscess was 255 d (range 21-733 d). One of these patients was treated by computed tomography-guided drainage and in 3 patients Hartmann’s procedure had to be performed. Two patients (10%) developed a local tumor recurrence and subsequently died.

CONCLUSION: Despite successful primary outcome, patients who receive endo-sponge therapy should be closely monitored in the first 2 years, since recurrence might occur.

Keywords: Rectal surgery; Anastomotic leakage; Endo-sponge; Endo-vacuum treatment