Published online Apr 14, 2022. doi: 10.3748/wjg.v28.i14.1394
Peer-review started: May 10, 2021
First decision: June 23, 2021
Revised: July 7, 2021
Accepted: March 4, 2022
Article in press: March 4, 2022
Published online: April 14, 2022
Processing time: 331 Days and 3.5 Hours
Endoluminal vacuum-assisted therapy (EVT) has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic patients. Its application has been mainly reserved to low colorectal and colo-anal anastomoses. The main advantage of this new procedure is to ensure continuous drainage of the abscess cavity, to promote and to accelerate the formation of granulation tissue resulting in a reduction of the abscess cavity. The reported results are promising allowing a higher preservation of the anastomosis when compared to conventional treatments that include trans-anastomotic tube placement, percutaneous drainage, endoscopic clipping of the anastomotic defect or stent placement. Nevertheless, despite this procedure is gaining acceptance among the surgical community, indications, inclusion criteria and definitions of success are not yet standardized and extremely heterogeneous, making it difficult to reach definitive conclusions and to ascertain which are the real benefits of this new procedure. Moreover, long-term and functional results are poorly reported. The present review is focused on critically analyzing the theoretical benefits and risks of the procedure, short- and long-term functional results and future direction in the application of EVT.
Core Tip: Endoluminal vacuum therapy for the treatment of rectal anastomotic leakage, in clinically stable patients, has been reported to be promising, in term of high rate of anastomotic salvage and length of hospital stay. Nevertheless, inclusion criteria, definition of success and complications, are heterogeneous. Moreover, long-term anorectal function is poorly reported. This opinion review aims at clarify, through a critical analysis, all the raised points to stimulate the surgical community to a more standardized approach and algorithm of treatment, and to further study the long-term consequences of this technique.