MULTIMEDIA ARTICLE Endoluminal vacuum therapy for anastomotic leaks after rectal surgery A. Arezzo • A. Miegge • A. Garbarini • M. Morino Received: 2 December 2009 / Accepted: 17 February 2010 / Published online: 30 March 2010 Ó Springer-Verlag 2010 Abstract Anastomotic leakage after rectal surgery is a very serious complication and is the main cause of postoperative morbidity and mortality. We describe three cases of rectal leakage which we treated with endoscopic vacuum-assisted closure. We used the Endo-SPONGE (B. Braun Aesculap AG, Germany), which consists of an open-cell, cylindrical polyurethane sponge connected to a drainage tube which is linked to a vacuum system to exert constant suction. The possible role of this new tool in the management of anastomotic leaks is also discussed. Keywords Endosponge Á Surgical wound dehiscence Á Negative pressure wound therapy Á Vacuum-assisted closure Introduction Anastomotic leaks are a major complication after rectal surgery and the main cause of morbidity and mortality in the postoperative period. We recently gained some expe- rience with the indications and contraindications for the use of the novel device Endo-SPONGE (B. Braun Aesculap AG, Germany). The device consists of an open-cell, cylindrical polyurethane sponge, cut to fit the estimated size of the abscess cavity to be treated (Fig. 1). The drain tube is connected to a Redyrob Trans Plus Ò bottle (B. Braun Aesculap AG, Germany) which exerts a constant suction at 120 psi. We present three exemplary cases in which we used endoluminal vacuum therapy with Endo-SPONGE. Case reports Case 1 (video 1) A 62-year-old woman with a history of obstructed defe- cation, but no other surgery, was transferred to our hospital on the 7th postoperative day after an internal Delorme procedure for the treatment of rectocele. The patient complained of local discomfort and fever up to 38.5°C. Endoscopy revealed an anterior anastomotic disruption and a draining fistula tract on each side. The right opening was wide enough to allow the introduction of the scope into an abscess cavity measuring 10 9 3 cm which was thor- oughly washed. Contrast injection through the irrigation channel demonstrated a communication between the abscess and the vagina. A fistula was confirmed at col- poscopy, as a pinpoint orifice in the posterior fornix. The Endo-SPONGE was inserted in the abscess cavity and replaced every 48 h without clinical improvement. After 6 days, a diverting loop colostomy on the descending colon was performed. The Endo-SPONGE was then replaced every 72–96 h as an inpatient, until complete obliteration of the cavity. At 21 days from the colostomy, the anasto- motic site was completely covered by mucosa and the patient discharged. Two months later, the patient had a Electronic supplementary material The online version of this article (doi:10.1007/s10151-010-0569-0) contains supplementary material, which is available to authorized users. A. Arezzo Á A. Miegge Á A. Garbarini Á M. Morino Digestive, Colorectal and Minimal Invasive Surgery, University of Turin, Turin, Italy A. Arezzo (&) Digestive, Colorectal and Minimal Invasive Surgery, University of Torino, Corso Dogliotti, 14, 10126 Torino, Italy e-mail: alberto.arezzo@unito.it; alberto.arezzo@mac.com 123 Tech Coloproctol (2010) 14:279–281 DOI 10.1007/s10151-010-0569-0