Ileoanal pouch salvage rates with endoluminal vacuum therapy for early vs late anastomotic leaks.

ABSTRACT

BACKGROUND: Anastomotic leaks after ileal pouch-anal anastomosis (IPAA) significantly compromise patient outcomes and increase healthcare resource utilization. The aim of this study was to evaluate the outcomes of endoluminal vacuum therapy (EndoVac) for pouch leaks. We hypothesized that EndoVac for early compared with late leaks was associated with a higher pouch survival rate. METHODS: We retrospectively reviewed consecutive pouch anastomotic leaks treated with EndoVac therapy at our institution between 2013 and 2023. Patients were stratified into early (≤30 days) and late (>30 days) leak groups. Anastomotic healing was defined as complete closure of the leak site and resolution of symptoms. Pouch failure was defined as a permanent ileostomy or pouch excision. The probability of pouch survival was estimated using the Kaplan-Meier method. RESULTS: A total of 14 patients with IPAA were included median age, 34 years; 71% were males; and median body mass index, 23.46 kg/m2. The following were the diagnoses made ulcerative colitis (n = 12) and familial adenomatous polyposis (n = 2). The median (IQR) time from pouch construction to leak was 44.5 (12-192) days; of these, 6 (43%) were early, and 8 (57%) were late. All (100%) leaks were at the anastomosis; all (100%) were diverted at the time of EndoVac therapy 10 (71%) still diverted, and 4 (29%) rediverted. Patients underwent a median of 5.5 EndoVac changes (3-7) over a 13.5 (6-21) day period from initiation of treatment to cessation of therapy. After EndoVac therapy, healing was observed in 10 (71%) patients; 2 of whom required a minor handsewn anastomotic revision but healed completely, and 4 did not heal; 3 had pouch excision, and 1 underwent redo pouch surgery. Anastomotic healing (66.7% vs 75%, P = .7) and pouch survival (83.3% vs 75%, P = .73) were not significantly different between the early and late leak groups. The overall pouch salvage rate was 78.5%. CONCLUSION: EndoVac therapy was effective in achieving high rates of pouch salvage and anastomotic healing in patients with ileoanal pouch leaks, irrespective of the timing of intervention postoperatively. This supports the use of EndoVac as a viable treatment option for both early and late anastomotic leaks.