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VACSTENT THERAPY FOR COLONIC ANASTOMOTIC LEAKAGE

Chantal Hasler 1, Tassili Weehuizen 1, Stephan Baumeler 1, Simon Bütikofer 1, Patrick Roger Aepli 1

Affiliations

1 Luzerner Kantonsspital, Lucerne, Switzerland

Summary

AI Generated

A case report describes successful treatment of a colorectal anastomotic leak using the VacStent GI Colon device, a self-expanding stent combined with endoscopic vacuum therapy that maintained stool passage without requiring diversion.

A 60-year-old patient with anastomotic leakage after rectosigmoid resection for perforated diverticulitis was treated with the VacStent GI Colon, an 80 mm self-expanding NiTi stent with a 60 mm polyurethane sponge middle section.
The device was connected to continuous negative pressure at -125 mmHg, changed twice during treatment (at 5 days and 12 days), and removed after a total of 20 days.
Endoscopy and CT imaging with rectal contrast showed complete resolution of the anastomotic leak with no residual leakage.
The authors conclude that this approach appears to be a promising alternative to conventional endoluminal sponge therapy, achieving rapid wound healing without requiring stool diversion.
This case report may interest clinicians managing colorectal anastomotic leaks who seek alternatives to proximal diversion.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Clinical Case Summary

Background: Endoscopic vacuum therapy (EVT) using sponges is recognized as an efficient approach for managing anastomotic leaks in the distal colon. However, the majority of patients needs additional proximal diversion and in case of anastomotic leakages it may not be possible to place the sponge into the cavity. The VacStent® merges the advantages of EVT and a fully covered self-expanding metal stent, accelerating wound healing and maintaining the natural anatomical pathway for unobstructed stool passage. The effectiveness of the VacStent® has been proven in treating upper gastrointestinal anastomotic leaks and esophageal perforations. It is conceivable that these advantages could extend to the colorectum.
Case description: Here we present the case of a 60-year-old patient with an anastomotic leakage following an anterior rectosigmoid resection with side-to-end descendorectostomy due to perforated sigmoid diverticulitis. The "VacStent GI Colon®", an 80 mm fully-covered, self-expanding NiTi stent with its middle 60 mm covered by a cylindrical polyurethane sponge and an inner diameter of 25 mm, was placed over the anastomosis and the defect. The VacStent® then was connected to a vacuum pump, providing continuous negative pressure at -125 mmHg. The VacStent® had to be changed twice: the first time 5 days after initial insertion, and then again 7 days later. EVT could successfully be discontinued after a total of 20 days, with no signs of anastomotic leakage observed neither endoscopically nor on CT abdomen with rectal contrast.
Conclusion: EVT in the distal colon using the VacStent® appears to be a successful and promising alternative to endoluminal sponge therapy, demonstrating rapid wound healing without the need for stool diversion.

References

Endoscopy pictures from our department that will be seen on the poster:
1 anastomotic leakage before vacuum therapy
2 anastomosis after the first stent-removal
3 VacStent in correct position in situ
4 ct-scan with the VacStent in situ
5 anastomosis after finished vacuum therapy

Conference

UEG Week Vienna 2024

Topics

Colorectal

Submission format

Clinical Case

Session

Rare clinical case presentations in lower GI (Posters)

Published

2024

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