Management of rectal anastomotic leaks using modified endoluminal vacuum therapy

BACKGROUND: Anastomotic leak (AL) remains one of the most feared complications following rectal surgery in stable patients with localized abscesses or contained leaks, nonoperative approaches may be considered, including broad-spectrum antibiotics, image-guided percutaneous drainage, transanal lavage and endoluminal vacuum therapy (EVT). METHOD: The procedure is performed under sedation with the patient in the left lateral Sims position. After assessing the defect location and size, a standard endoscope is introduced, and a guidewire is used to measure the cavity length, the distal end of the cavity. A sponge is prepared to cover the distal portion of the defect. The catheter tip remains sponge-free but is perforated and positioned at the apex of the cavity using the over-the-guidewire technique or by direct placement with endoscopic large grasping forceps. RESULTS: We applied this method to a total of 3 patients. We applied it twice to the first two patients and three times to the third patient. In one patient, the abscess and sinus condition improved. In two patients, the sinus closed completely. In three patients, the opening at the anastomosis was almost completely repaired after 3 sessions. No complications occurred during the procedures. CONCLUSION: Modified EVT is a cost-effective, easy-to-assemble and patient-specific version of traditional vacuum therapy. Its ability to accommodate irregular leakage spaces allows for more efficient negative-pressure application, accelerates cavity collapse and granulation and improves patient comfort by allowing for longer change intervals. This technique can broaden access to EVT and improve outcomes in selected patients.