Early reconstruction of the leaking ileal pouch‐anal anastomosis: a novel solution to an old problem. (May 2015)

• Record Type: Journal Article
• Authors: 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.
• Is Part Of: Colorectal disease. Volume 17:Number 5(2015)
• Page Start: 426
• Page End: 432
• Publication Date: 2015-05
• Subjects: Ileal pouch‐anal anastomosis -- inflammatory bowel disease -- anastomotic leakage -- vacuum assisted therapy -- Endo‐sponge®; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.12867
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: 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.