Endoluminal vacuum-assisted therapy to treat rectal anastomotic leakage: A critical analysis

Table 1 Inclusion criteria among different studies

Ref.	# Patients	Anastomosis location	Inclusion criteria	Type of disease (n)	Neoadjuvant therapy (%)
Weidenhagen et al[7], 2008	29	Lower rectum; Middle rectum	Local peritonitis (20); General peritonitis (9)	Cancer of the rectum (22); Rectosigmoid cancer (3); Benign disease (4)	9 (40.9)
von Bernstorff et al[27], 2009	26	Lower rectum; Ileorectal	Local peritonitis	Cancer of the rectum + rectosigmoid	14 (54)
Riss et al[30], 2010	20	Lower rectum; Middle rectum	Not reported	Cancer of the rectum	6 (30)
van Koperen et al[8], 2009	16	Lower rectum; Ileo-anal	Not reported	Cancer (13); Ulcerative colitis (3)	9 (56)
Nerup et al[25], 2013	13	Lower rectum	Local peritonitis	Cancer	6 (46.1)
Mees et al[23], 2008	5	Lower rectum	Local peritonitis Abscess (> 3 cm × 3 cm, or < 10 cm × 10 cm)	Cancer of the rectum	No
Arezzo et al[15], 2015	14	Lower rectum	Local peritonitis	Cancer of the rectum (7); Other (1)	7 (50)
Strangio et al[11], 2015	25	Lower rectum (19); Middle rectum (5); Ileoanal (1)	Local peritonitis Anastomotic leak less than 270	Rectal cancer (18); Endometriosis (1); Left sided colon cancer (4); Diverticulitis (1); Ulcerative colitis (1)	18 (84)
Mussetto et al[31], 2017	11	Lower rectum(8); Middle (3)	Local peritonitis	Rectal cancer	5 (45)
Keskin et al[13], 2015	15	3 (20)	Local peritonitis	Rectal cancer (12); Other (3)	NR
Milito et al[16], 2017	14	Lower rectum	Local peritonitis	Cancer of the rectum	14 (100)
Srinivasamurthy et al[14], 2013	8	Lower rectum; Ileoanal	Not reported	Ulcerative colitis (1); Cancer of the rectum (8)	8 (100)
Abdalla et al[24], 2020	47	Middle (5); Lower (42)	Local peritonitis + asymptomatic leak	Cancer of the rectum (44); Other (3)	27 (57.4)
Kühn et al[28], 2021	281	Lower rectum; Ileoanal; Middle rectum	Local peritonitis extraperitoneal anastomotic leak; Rectal defect	Sigmoid or rectal cancer 183 (65); Other malignancies 50 (18); Diverticular disease 17 (6); Inflammatory bowel disease 12 (4); Perforation 8 (3); Benign/malignant diseases 11 (4)	84 (30)

Table 2 Reported complications and treatment among studies reporting complications

Ref.	# Patients	Overall complications n (%)	Type of complication	Treatment	Ileostomy closure %
Weidenhagen et al[7], 2008	29	10 (34.5)	10 anastomotic stenosis; 2 fistulas	Bougienage/balloon dilatation (n = 10); Hartmann procedure for persistent fistula (n = 1)	88
von Bernstorff et al[27], 2009	26	2 (7.7)	2 intra-abdominal fistulas	Hartmann procedures (n = 2)	NR
Riss et al[30], 2010	23	6 (23)	1 stenosis; 5 recurrent abscess	Dilatation for stenosis (n = 1); Hartmann’s procedure (n = 3); CT-guided drainage (n = 1); No further action (n = 1)	76.5
van Koperen et al[8], 2009	16	4 (25)	2 abscesses; 1 bleeding; 1 severe pain; 1 anastomotic stenosis	Hartmann procedure for recurrent abscess (n = 2); 1 stopped treatment for pain; 1 dilatation for stenosis	55.6
Nerup et al[25], 2013	13	1 (7.7)	1 anastomotic stenosis	Permanent colostomy (n = 1)	91
Mees et al[23], 2008	5	1 (20)	1 anastomotic stenosis	Dilatation (n = 1)	20
Arezzo et al[15], 2015	14	1 (14)	1 peritonitis; 2 poor compliance	Fibrin glue injection	NR
Strangio et al[11], 2015	25	3 (12)	2 fistulas (1 ureteric, 1 ileal); 1 recurrent abscess	Surgery (n = 3)	84.6
Mussetto et al[31], 2017	11	2 (18)	2 anastomotic stricture	1 endoscopic dilatation; 1 stent placement	91
Keskin et al[13], 2015	15	3 (20)	2 pelvic sepsis; 1 bleeding	Treatment discontinued	71
Milito et al[16], 2017	14	5 (36)	Moderate pain	None	NR
Srinivasamurthy et al[14], 2013	8	1 (12)	Iatrogenic injury during sponge placement	End stoma	64
Abdalla et al[24], 2020	47	4 (8.5)	1 intractable pelvic pain; 3 anastomotic stenosis	Treatment discontinued (pain); Endoscopic dilatation	NR
Kühn et al[28], 2021	281	27 (10)	10 anastomotic stenosis; 7 rectovaginal fistulas; 4 bleeding	Endoscopic dilatation (n = 10); Surgery (n = 7); Endoscopic haemostasis (n = 3); Surgery for intractable beelding (n = 1)	62

NR: Not reported.

Table 3 Assessment of ano-rectal function after treatment of anastomotic leak with endoluminal vacuum-assisted therapy

Ref.	# Patients	# Patients with functional assessment	Follow-up time	Instrument to evaluate ano-rectal function	Results
Borstlap et al[17], 2018	30	15	6, 9, 12 mo	LARS score; COREFO	81% major LARS; 13% minor LARS
Huisman et al[36], 2019	20	13	2.6 (0.8-3.5) yr	LARS score	77% major LARS; 23% minor LARS
Katz et al[42], 2018	6	4	Not reported	None	Reasonable function
Srinivasamurthy et al[14], 2013	8	6	41 (10-45) mo	None	Good or reasonable function
Abdalla et al[24], 2020	47	17	14.8 ± 8.9 mo	LARS score	47.1% major LARS; 52.9% no or minor LARS
Rottoli et al[12], 2018	8 (pouch)	7	11.6 (6-18) mo	None	No feces or gas incontinence; BM: Daytime: 5 (3-8); Nighttime: 1.7 (1-4)
Weréen et al[43], 2020	14	6	5.9 (0.53-13) yr	LARS score	67% major LARS

LARS: Low anterior resection syndrome score; COREFO: Colorectal functional outcome; BM: Bowel movements.