Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2022; 28(28): 3747-3752
Published online Jul 28, 2022. doi: 10.3748/wjg.v28.i28.3747
Endoluminal vacuum-assisted therapy as a treatment for anastomotic leakage in colorectal surgery
Maria Michela Chiarello, Valentina Bianchi, Pietro Fransvea, Giuseppe Brisinda
Maria Michela Chiarello, Department of Surgery, Azienda Sanitaria Provinciale di Cosenza, Cosenza 87100, Italy
Valentina Bianchi, Pietro Fransvea, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, taly
Giuseppe Brisinda, Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Author contributions: Chiarello MM and Brisinda G conceived the original idea; Fransvea P and Bianchi V performed a comprehensive review of all available literature and summarized the data; Brisinda G and Chiarello MM meet the criteria for authorship established by the International Committee of Medical Journal Editors and verify the validity of the results reported; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Brisinda, MD, Professor, Surgeon, Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. gbrisin@tin.it
Received: April 16, 2022
Peer-review started: April 16, 2022
First decision: May 11, 2022
Revised: May 13, 2022
Accepted: June 22, 2022
Article in press: June 22, 2022
Published online: July 28, 2022
Abstract

Anastomotic leakage (AL) has a wide range of clinical features ranging from radiological only findings to peritonitis and sepsis with multiorgan failure. An early diagnosis of AL is essential in order to establish the most appropriate treatment for this complication. Despite AL continues to be a dreadful compli-cation after colorectal surgery, there has been no consensus on its management. However, based on patient’s presentation and timing of the AL, there has been a gradual shift to a more conservative management, keeping surgery as the last option Reoperation for sepsis control is rarely necessary especially in those patients who already have a diverting stoma at the time of the leak. A nonoperative management is usually preferred in these patients. There are several treatment options, also for patients without a stoma who do not require a reoperation for a contained pelvic leak, including recently developed endoscopic procedures, such as clip placement or endoluminal vacuum-assisted therapy. More conservative treatments could be an option in patients who are clinically stable or in presence of a small defect.

Keywords: Anastomotic leakage, Colorectal cancer, Colorectal surgery, Mortality, Morbidity

Core Tip: The authors of the review have a remarkable clinical experience and scientific authority in colorectal surgery and related complications. The authors focus their attention on endoluminal vacuum therapy to treat anastomotic leakage in colorectal surgery. The authors highlight that most studies are heterogeneous in term of success rate definition, salvage and long-term results. Furthermore, there is paucity of comparative studies and thus definitive conclusions are not warranted at present time, as pointed out by the authors in their narrative review.