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Early reconstruction of the leaking ileal pouch‐anal anastomosis: a novel solution to an old problem
Author(s) -
Gardenbroek T. J.,
Musters G. D.,
Buskens C. J.,
Ponsioen C. Y.,
D'Haens G. R. A. M.,
Dijkgraaf M. G. W.,
Tanis P. J.,
Bemelman W. A.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12867
Subject(s) - medicine , anastomosis , surgery , pouch , interquartile range , leak , environmental engineering , engineering
Aim The study aimed to determine the effectiveness and direct medical costs of early surgical closure of the anastomotic defect after a short course of Endo‐sponge® therapy of the presacral cavity, compared with conventional treatment in patients with anastomotic leakage after ileal pouch‐anal anastomosis ( IPAA ). Method Patients with anastomotic leakage after IPAA undergoing early surgical closure of the anastomotic defect after a short Endo‐sponge® treatment were prospectively followed and compared with a consecutive cohort of patients with an anastomotic leak treated by creation of a loop ileostomy and occasional drainage of the presacral cavity. Results A total of 15 patients were treated with early surgical closure and 29 were treated conventionally. In the early surgical closure group, the Endo‐sponge® treatment was continued for a median of 12 days [interquartile range ( IQR ) 7–15 days] with a median of 3 ( IQR 2–4) Endo‐sponge® changes. Secondary anastomotic healing was achieved in all patients ( n = 15) in the early surgical closure group compared with 52% ( n = 16) in the conventional treatment group ( P = 0.003). Closure of the anastomotic defect was achieved after a median of 48 (25–103) days in the early surgical closure group compared with 70 ( IQR 49–175) days in the conventional treatment group ( P = 0.013). A functional pouch was seen in 93% and 86% of the patients in each group. There was no significant difference in direct medical cost. Conclusion Early surgical closure after a short period of Endo‐sponge® treatment is highly effective in treating anastomotic leakage after IPAA without increasing cost.