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Updated: May 27, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Early, minimally invasive closure of anastomotic leaks: a new concept
T Verlaan1, S A L Bartels, M I van Berge Henegouwen
1Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Insights
Early closure of low anastomotic leaks using endosponge therapy can prevent chronic pelvic sepsis after ileoanal or coloanal anastomosis. This minimally invasive approach improves neorectal function by addressing leaks promptly.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Pelvic Surgery
Background:
- Chronic pelvic sepsis is a significant complication following ileoanal or coloanal anastomosis.
- This sepsis hinders ileostomy closure and impairs neorectal function.
Purpose of the Study:
- To evaluate the efficacy of early minimally invasive closure for low anastomotic leaks.
- To determine if early intervention can prevent chronic pelvic sepsis and its sequelae.
Main Methods:
- A consecutive series of six patients with low anastomotic leaks underwent early closure.
- Techniques included endosponge therapy followed by suture or endoscopic clip repair.
- Para-anastomotic cavity drainage and anastomosis defunctioning were crucial.
Main Results:
- Five out of six patients achieved successful anastomotic closure.
- Early closure prevented the development of chronic pelvic sepsis in the treated cases.
Conclusions:
- Minimally invasive closure of low anastomotic leaks is feasible and effective.
- Prompt management of leaks with endosponge therapy, drainage, and defunctioning can preserve neorectal function and avoid sepsis.
Abstract:
Chronic pelvic sepsis after ileoanal or coloanal anastomosis precludes ileostomy closure and, even if closure is ultimately possible, function of the neorectum is badly affected. Early closure of the anastomotic leak might prevent chronic pelvic sepsis and its adverse sequelae. In our experience of early closure in a consecutive group of six patients with a leaking low anastomosis (five with ileoanal pouch anastomosis and one after a low anterior resection), we were able to achieve anastomotic closure in five by means of initial endosponge therapy followed either by early suture (four patients) or endoscopic clip repair (one patient). Early minimally invasive closure of low anastomotic leaks is therefore possible provided that the para-anastomotic cavity is drained well prior to closure and the anastomosis is defunctioned.
