Background: Anastomotic leak is one of the most challenging complications after colorectal surgery. Low colorectal, coloanal and ileal pouch-anal anastomoses are at highest risk of developing anastomotic leak. Endoluminal-Vacuum-Assisted Therapy (EVAT) has been proposed as an effective treatment, however, the best timing of the procedure remains unclear. The aim of the study was to compare the outcomes of EVAT as a first-stage vs. second-stage (following other operative procedures) treatment.
Methods: Retrospective study including patients undergoing EVAT after confirmed anastomotic leak in a single centre between November 2019 and November 2022. EVAT was applied either as a first-stage treatment or a second-stage treatment based on the individual case. The device was positioned in the cavity and replaced until the gap was reduced in size and covered by granulating tissue. The resolution of the anastomotic leak was confirmed at the endoscopy .
Results: Of the 25 patients who were included, 9 underwent first-stage EVAT, while 16 underwent second-stage EVAT. The anastomotic leak was diagnosed at a median of 14 days (range 10-413) after surgery for the first-stage group and 38 days (range 11-362) in the second-stage group (p=0.82). The time of EVAT from the onset of the leak was 7 days (1-60) in the first-stage group and 76 (6-780) days in the second-stage group (p=0.058). The resolution of the anastomotic leak was significantly higher in the first-stage EVAT group 88,9% vs 37,6% in the second-stage group, (p = 0.033).
Conclusions: The present study confirms the effectiveness of the EVAT in the treatment of low anastomotic leaks, in particular when it is used as a first treatment after diagnosis.