Let's Talk About Leaks!
Anastomotic leakage is the most feared complication in rectal surgery, and its consequences are significant, both at the economic level and in terms of quality of life, and mortality, and may even carry an increased locoregional recurrence risk. The risk factors for leakage have been well identified, including low anastomoses, obesity, male gender, smoking, steroids, neoadjuvant chemoradiotherapy, and anastomotic tension. The classic method of treatment of a patient who suffers from a symptomatic anastomotic leakage is fecal diversion – if a stoma has not been primarily constructed – together with peritoneal washout, drain placement, and drainage of possible pelvic collections. In 2006, a new treatment modality was described, which consists of the endoscopic placement of a vacuum sponge in the abscess cavity, connected to a negative pressure device. This therapy has been proven to be a feasible and safe option for leak management, with several studies reporting high rates of complete anastomotic healing and stoma reversal. In the CLEAN study, a treatment protocol based on vacuum sponge and an early transanal suturing of the defect, was described. The anastomosis healed in 70% of the patients, and bowel continuity was restored in 67%. However, further studies are required to draw definitive conclusions.