Milito Giovanni, Lisi Giorgio, Venditti Dario, Campanelli Michela, Aronadio Elena, Grande Simona, Cabry Francesca, Grande Michele
Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
Department of Surgery, University Hospital of Borgo Roma, Verona, Italy.
Surg Technol Int. 2017 Jan 10;30:125-130.
The clinical leakage rate after anterior resection varies from 2.8-20%, with a 6-22% mortality rate and a 10-80% risk of permanent stoma. Endo-SPONGE® (B. Braun Melsungen AG, Melsungen, Germany) may treat extraperitoneal anastomotic leakage in the lesser pelvis. It consists of an open-pored sponge inserted into the cavity. A drainage tube fixed to a low vacuum drainage system is then connected to the sponge through the anus.
Between January 2007 and December 2014, 14 patients with anastomotic leakage following low anterior resection were treated with Endo-SPONGE® and were prospectively evaluated. In all patients, a CT-scan was performed and they received an intravenous antibiotic therapy with piperacillin+tazobactam (4.5g,3 times/daily). Complete healing was defined as endoscopically proven closure of the insufficiency cavity with a normal mucosa.
Stapled straight end to end, colorectal anastomoses were performed in all patients between 3-7 cm above the anal verge, a protective loop ileostomy was performed in every patient. The diagnosis of anastomotic leakage was performed after a median interval of 14 days, the median size of the cavity was 81x46 mm. Fluid collection was drained, percutaneosly in 12 cases, surgically in two patients. The median duration of therapy was 35 days, with 3-14 sponge exchanges for each patient. Median healing time was 37 days. No intraoperative complications were recorded, however, we found five cases of mild anal pain treated medically.
Considering the literature and our results, the Endo-SPONGE® seems an effective, minimally invasive procedure to treat extraperitoneal anastomotic leakage, reducing morbidity, mortality, and hospital stay.
前切除术术后临床漏出率在2.8%至20%之间，死亡率为6%至22%，永久性造口风险为10%至80%。Endo-SPONGE®（德国梅尔松根市贝朗医疗股份公司）可治疗盆腔较低部位的腹膜外吻合口漏。它由一个插入腔内的开孔海绵组成。然后将一根固定在低负压引流系统上的引流管通过肛门连接到海绵上。
2007年1月至2014年12月，对14例低位前切除术后吻合口漏患者采用Endo-SPONGE®进行治疗，并进行前瞻性评估。所有患者均进行了CT扫描，并接受了哌拉西林+他唑巴坦（4.5g，每日3次）的静脉抗生素治疗。完全愈合定义为经内镜证实缺损腔闭合且黏膜正常。
所有患者均在齿状线上方3至7厘米处进行了端端吻合的结肠直肠吻合术，每位患者均进行了保护性回肠造口术。吻合口漏的诊断在中位间隔14天后进行，缺损腔的中位大小为81×46毫米。12例患者经皮引流积液，2例患者手术引流。中位治疗持续时间为35天，每位患者进行3至14次海绵更换。中位愈合时间为37天。未记录术中并发症，然而，我们发现5例轻度肛门疼痛患者经药物治疗。
结合文献和我们的结果，Endo-SPONGE®似乎是一种治疗腹膜外吻合口漏的有效、微创方法，可降低发病率、死亡率和住院时间。
