Vacuum-assisted self-expanding stents in colorectal surgery: early experiences with a novel tool

Anastomotic leakage (AL) remains a dreaded complication following colorectal resections. The routine use of diverting loop ileostomies (DLI), is associated with significant morbidity, triggering interest in alternative strategies. The VACStent Colon (VSC), a novel endoscopic treatment, combines vacuum-assisted closure with a self-expanding stent, providing luminal patency. Here we report our 1-year experience with the VSC.

Retrospective analysis of patients treated with VSC at our department from 02/2024 to 03/2025 either therapeutically for AL or prophylactically in high-risk anastomoses. Outcomes, including continuous luminal patency by VSC, AL healing, complications, and need for DLI, were assessed with follow-up until endoscopic healing (EH) of AL.

Thirteen patients received a total of 47 VSC. Continuous luminal patency was achieved in 89.4%. Overall, 10 patients were treated with therapeutic intent (43 VSC). Nine patients achieved EH under VSC therapy (6 with DLI close, 2 awaiting DLI, one managed without DLI). One patient did not achieve EH. Three patients underwent prophylactic VSC therapy following high-risk anastomoses without a DLI. Notably, no AL occurred in this group. The most commonly observed complication was pain, particularly in distally placed VSC. Outpatient VSC therapy was successfully implemented in select cases.

VSC shows promising results as therapeutic tool for treating colorectal AL and as prophylactic measure in high-risk anastomoses. It offers the benefits of vacuum therapy combined with mechanical stenting providing luminal patency, potentially reducing the need for DLI.