Endo-sponge assisted treatment of anastomotic leakage following colorectal surgery

Endo-sponge assisted treatment (endo-sponge) represents a novel approach to treat patients with anastomotic dehiscence following anterior resection for rectal cancer. Yet, limited data are available to predict success, compatibility with radiotherapy and/or chemotherapy as well as acceptance by the patients.

Between September 2007 and June 2008, nine patients suffering from anastomotic leakage after anterior rectal resection (n = 6) or suffering from leakage of rectal stump following Hartmann's procedure (n = 3) were treated by endo-sponge. We recorded clinical outcome and patient's comfort using a 10-point visual analogue scale (VAS).

Median time of endo-sponge treatment was 3 weeks (range: 2-8). There were no minor or major complications. In 6 (66.6%) patients, the anastomotic leakage healed successfully. Three patients showed no response and needed further surgical intervention. The lack of success was due to complexity of the leakages, which comprised either more than 270 degrees of the circumference or consisted of two distant fistulas. Formation of granulation tissue was unaffected by chemotherapy. For the question 'alteration in daily life activity', a median score of 5 (range: 1-9) was found. Measuring 'pain sensation' during endo-sponge treatment patients scored a median of 3 (range: 0-6).

Endo-sponge treatment can be recommended as an alternative approach to treat pelvic sepsis following anastomotic dehiscence or rectal stump insufficiency. Extended leakages should be treated by different approaches having little probability of successful healing, but can lead to discomfort for the patient. Radiochemotherapy does not cause a problem for application of the endo-sponge.