Instruction Video for Endosponge Construction

Introduction: Gastrointestinal perforations and leaks have historically caused significant morbidity and mortality. 1 Advanced endoscopic techniques have revolutionized minimally invasive techniques in addressing leaks (e.g., esophageal stents). 2 Endoluminal negative pressure wound therapy (NPWT) has been introduced as a possible technique for treating colorectal anastomotic leaks in appropriately selected patients. 3 However, resources showing how to assemble the occlusive foam dressing are limited. We present a video exhibiting how to create the endosponge using basic supplies including a nasogastric tube (NGT). Case Presentation: A 33-year-old female initially presented with severe pelvic pain, urinary retention, and difficulties with defecation. Workup was notable for a 9.4 × 11.3 × 10.2 cm presacral cystic mass. The patient initially underwent excision, requiring excision of the posterior rectal wall, coccyx, and a loop sigmoid colostomy. Despite months of appropriate diversion, the posterior rectal wall failed to heal adequately and the patient had a persistent presacral abscess. Endoluminal NPWT was thereby recommended. Materials and Methods: Patient selection is critical in deciding candidacy for endoluminal wound therapy (Endovac). Endovac is an effective solution for sealing sinus-like defects rather than wider, crater-like defects where exposure to rectal mucosa leads to suction loss and difficulty in maintaining a seal. Defects located closer to the anal verge can be managed more successfully with this technique given the ease in accessing/visualizing the defect using conventional anoscopy. An endosponge is created using a small-bore NGT and negative pressure wound therapy supplies. To optimize functionality and prevent suction loss, the NGT is carefully trimmed to remove any redundant side holes such that the residual side holes are positioned entirely within the pararectal cavity. This ensures exclusion of side holes from the rectal lumen, which would inevitably compromise suction efficiency. The black sponge from the wound vac is cut to fit the rectal cavity being treated. 4 The sponge is then secured onto the distal end of the NGT using a two-point anchor technique as demonstrated in the video. The NGT is connected to the wound vac tubing, and the wound vac is set at 125 mmHg continuous suction. Results: The patient started with transrectal NPWT placement with exchanges 2x/week for approximately 4 weeks with a progressive decrease in the transrectal cavity size. The patient remained asymptomatic following removal. Conclusion: Instructions on creating the device used for endoluminal negative pressure wound therapy are limited. Given the increasing utility of Endovacs in highly selected patients presenting with gastrointestinal leaks, educational videos on the creation of Endovac components are needed. A patient case inspired the creation of this video. However, no patients are recorded in the video. Patient consent was thereby waived. There was no funding provided for this study. The authors declare that they have no conflicts of interest. The authors declare no commercial associations within the last three years that may create a conflict of interest in connection to the video. Patient consent was waived for the video, as no patients are recorded in the video. Prior Presentations: The results from this video were presented at the 2023 American Society of Colon and Rectal Surgeons (ASCRS) Annual Scientific Meeting (Seattle, WA), 6/3-6/6. Runtime of video: 5 mins, 5 secs.