Opinion Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2022; 28(14): 1394-1404
Published online Apr 14, 2022. doi: 10.3748/wjg.v28.i14.1394
Endoluminal vacuum-assisted therapy to treat rectal anastomotic leakage: A critical analysis
Andrea Vignali, Paola De Nardi
Andrea Vignali, Paola De Nardi, Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milano 20132, Italy
Andrea Vignali, Department of Surgery, Vita-Salute University, Milano 20132, Italy
Author contributions: Vignali A conceived the idea for the manuscript; Vignali A and De Nardi P reviewed the literature and drafted the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Paola De Nardi, FASCRS, MD, Staff Physician, Surgeon, Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milano 20132, Italy. denardi.paola@hsr.it
Received: May 10, 2021
Peer-review started: May 10, 2021
First decision: June 23, 2021
Revised: July 7, 2021
Accepted: March 4, 2022
Article in press: March 4, 2022
Published online: April 14, 2022
Processing time: 331 Days and 3.5 Hours
Abstract

Endoluminal vacuum-assisted therapy (EVT) has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic patients. Its application has been mainly reserved to low colorectal and colo-anal anastomoses. The main advantage of this new procedure is to ensure continuous drainage of the abscess cavity, to promote and to accelerate the formation of granulation tissue resulting in a reduction of the abscess cavity. The reported results are promising allowing a higher preservation of the anastomosis when compared to conventional treatments that include trans-anastomotic tube placement, percutaneous drainage, endoscopic clipping of the anastomotic defect or stent placement. Nevertheless, despite this procedure is gaining acceptance among the surgical community, indications, inclusion criteria and definitions of success are not yet standardized and extremely heterogeneous, making it difficult to reach definitive conclusions and to ascertain which are the real benefits of this new procedure. Moreover, long-term and functional results are poorly reported. The present review is focused on critically analyzing the theoretical benefits and risks of the procedure, short- and long-term functional results and future direction in the application of EVT.

Keywords: Anastomotic leakage; Rectal surgery; Endoluminal vacuum therapy; Endo-sponge; Complications

Core Tip: Endoluminal vacuum therapy for the treatment of rectal anastomotic leakage, in clinically stable patients, has been reported to be promising, in term of high rate of anastomotic salvage and length of hospital stay. Nevertheless, inclusion criteria, definition of success and complications, are heterogeneous. Moreover, long-term anorectal function is poorly reported. This opinion review aims at clarify, through a critical analysis, all the raised points to stimulate the surgical community to a more standardized approach and algorithm of treatment, and to further study the long-term consequences of this technique.