AI Article Synopsis
- The study evaluates the effectiveness of the Endo-SPONGE device in treating leaks from rectal anastomoses, involving a systematic review of relevant literature.
- A total of sixteen studies were analyzed, featuring 266 patients, revealing an 11.8% median treatment failure rate and potential benefits when treatment starts early, while neoadjuvant radiotherapy correlated with increased failure.
- The Endo-SPONGE may be beneficial in selected patients, but the overall data quality is low and more robust studies are necessary for conclusive findings.
Article Abstract
Background: The aim of this study was to assess the efficacy of an endoluminal vacuum device (Endo-SPONGE) in the treatment of rectal anastomotic leaks.
Methods: All studies looking at endoluminal vacuum therapy with Endo-SPONGE in the treatment of rectal anastomotic leaks were included. A comprehensive search was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Primary outcome was defined as the rate of total anastomotic salvage, with secondary outcomes including rate of ileostomy closure, additional transrectal closures and functional outcomes RESULTS: Sixteen studies met the inclusion criteria. There was a significant publication bias (z = 3.53, p = 0.0004). Two hundred sixty-six patients were identified. The median treatment failure rate was 11.8% (range 0-44%), with random effects model of 0.17 (95% CI 0.11-0.22). There was improvement with early therapy start (OR 3.48) and negative correlation with neoadjuvant radiotherapy (OR 0.56). Fifty-one percent of all diverting stomas were closed at the end of treatment period and 12.8% of patients required an additional trans-rectal closure of the abscess cavity.
Conclusions: Endo-SPONGE seems to be a useful method of rectal anastomotic leak treatment in selected group of patients; however, the quality of available data is poor and it is impossible to draw a final conclusion. There is unexpected high rate of permanent ileostomy. There is a need for further assessment of this therapy with well-designed randomised or cohort studies.
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| http://dx.doi.org/10.1007/s10151-020-02200-1 | DOI Listing |
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