EP2028 - Endoscopic Vacuum‐Assisted Closure (EndoVac) Therapy Treatment of Anastomotic Leak After Altemeier Procedure

Purpose/Background: Colorectal anastomotic dehiscence, commonly referred to as anastomotic leak, is a serious complication following colorectal surgery. This condition notably raises morbidity and mortality rates, and the duration of hospital stay. By assessing and understanding the preoperative, intraoperative, and postoperative factors that elevate the risk of leaks, surgeons can make more informed and effective management decisions. Endoscopic vacuum therapy (EndoVac) has been shown to be a safe and effective solution for anastomotic leaks. We report a case where EndoVac was utilized to treat persistent anastomotic dehiscence in a malnourished patient after an Altemeier procedure for rectal prolapse.

Methods/Interventions: A 76-year-old woman underwent an Altemeier procedure for rectal prolapse. On post operative day 1, she developed increased abdominal pain and bandemia and underwent a CT which showed a leak at the site of the anastomosis. Abdominal washout and diverting loop ileostomy creation was performed after an exam under anesthesia showed a small anterior defect. Following CT scans showed perianastomotic collection requiring IR drainage, with improvement and initial discharge.

Results/Outcomes: Approximately one month later, the patient represented in the ED with recurrence of pelvic collection. She was admitted at that time and treated with broad spectrum antibiotics. Subsequently, she underwent repeat drainage of the soft tissue collection, followed by flexible sigmoidoscopy showing persistent large anterior defect and cavity with purulence. Multiple endoscopic washouts were performed with eventual upsizing of IR drain. After resolution of purulent drainage, application of an endoscopic vacuum-assisted closure (EndoVac) device into the cavity was performed. The EndoVac was changed on a weekly basis, effectively managing the defect. The patient clinically improved over this admission with flexible sigmoidoscopies showing progressive shrinking of the cavity. Interval CT scan was obtained during admission showing no extraluminal contrast extravasation. Flexible sigmoidoscopy 23 days after initial placement showed healed mucosal defect with closed cavity and the endovac was discontinued. With toleration of diet, patient was discharged to SAR.

Conclusion/Discussion: This case underscores the significant potential of Endovac therapy as a non-invasive and promising surgical alternative for the treatment of select cases of anastomotic leak and prevention of permanent stoma. Notably, Endovac demonstrates a high rate of success with minimal associated complications, thus affirming its efficacy in the management of complex clinical scenarios and reinforcing its prominence within the field of colorectal surgery.