Kaya Selçuk, Çevik Muhammet Kerim, Alomari Omar, Mokresh Muhammed Edib, Kucuk Hasan Fehmi
Department of General Surgery, University of Health Sciences Kartal Dr. Lutfi Kirdar City Hospital, Istanbul-Türkiye.
Hamidiye International School of Medicine, University of Health Sciences, Istanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2025 May;31(5):450-457. doi: 10.14744/tjtes.2025.27078.
Anastomotic leakage is a significant complication following colorectal surgery, associated with increased morbidity and mortality. Endoluminal vacuum therapy (EVT) has emerged as a promising treatment option for managing such leaks, although stan-dardized guidelines are still lacking. This study aimed to evaluate the efficacy of EVT in managing anastomotic leakage after colorectal surgery, focusing on outcomes and contributing factors.
A retrospective analysis was conducted on 25 patients who underwent EVT for anastomotic leakage between 2018 and 2022 at our institution. Data collected included patient demographics, surgical details, timing of EVT initiation, number of EVT sessions, complications, and outcomes such as leak closure and subsequent surgical interventions. Statistical analyses were performed using Python packages.
The study cohort had a mean age of 56.84 years, with 68% being male. All patients received neoadjuvant therapy followed by low anterior resection and diverting ileostomy; 80% underwent open surgery. EVT was initiated for postoperative anastomotic leak-age, with a mean hospital stay of 14.16 days and an average initiation time of 16.16 days post-surgery. Ileostomy closure was performed in 14 patients after endosponge therapy. The overall EVT success rate was 68%, with a mean follow-up period of 30.7 months for those who underwent ileostomy closure. No significant relationship was found between patients' age and the time to first EVT after anastomotic leakage (p=0.52). However, a significant association was observed between the timing of the first EVT and the duration of EVT termination (p=0.0003).
EVT is a viable option for managing anastomotic leakage following colorectal surgery, demonstrating high closure rates and low associated morbidity. Early initiation of EVT appears to be crucial for optimizing treatment outcomes. Further pro-spective studies are needed to establish standardized protocols and confirm the long-term benefits of EVT in this challenging clinical context.
吻合口漏是结直肠手术后的一种严重并发症，与发病率和死亡率的增加相关。腔内负压治疗（EVT）已成为处理此类漏口的一种有前景的治疗选择，尽管仍缺乏标准化指南。本研究旨在评估EVT在结直肠手术后处理吻合口漏方面的疗效，重点关注结局和相关因素。
对2018年至2022年在我院接受EVT治疗吻合口漏的25例患者进行回顾性分析。收集的数据包括患者人口统计学资料、手术细节、EVT开始时间、EVT疗程数、并发症以及漏口闭合和后续手术干预等结局。使用Python软件包进行统计分析。
研究队列的平均年龄为56.84岁，68%为男性。所有患者均接受新辅助治疗，随后行低位前切除术和转流性回肠造口术；80%接受开放手术。因术后吻合口漏开始进行EVT，平均住院时间为14.16天，术后平均开始时间为16.16天。14例患者在海绵栓治疗后进行了回肠造口关闭术。EVT的总体成功率为68%，接受回肠造口关闭术的患者平均随访期为30.7个月。未发现患者年龄与吻合口漏后首次进行EVT的时间之间存在显著关系（p = 0.52）。然而，首次EVT的时间与EVT结束的持续时间之间存在显著关联（p = 0.0003）。
EVT是结直肠手术后处理吻合口漏的一种可行选择，显示出高闭合率和低相关发病率。早期开始EVT似乎对优化治疗结局至关重要。需要进一步的前瞻性研究来建立标准化方案，并证实EVT在这一具有挑战性的临床背景下的长期益处。
