eP474 - Customized Application of Endoscopic Vacuum‐Assisted Closure (EndoVac) Therapy for Managing Colorectal Anastomotic Dehiscence

Purpose/Background: Colorectal anastomotic dehiscence, also known as anastomotic leakage, is a severe complication after colorectal surgery. It significantly increases morbidity, mortality, and the length of hospital stay. Evaluating and understanding the preoperative, intraoperative, and postoperative factors that increase the risk of leaks in patients significantly aids surgeons in making more informed and effective decisions and judgments for management. Endoscopic vacuum therapy (EndoVac) has been demonstrated as a safe and effective treatment for rectal anastomotic leaks. We present a case of using EndoVAC to treat chronic anastomotic dehiscence in a patient actively receiving intense chemotherapy and presenting with a soft tissue infection. Our primary aim was not strictly focused on achieving total healing, but rather on managing sepsis effectively using the EndoVac approach.Methods/Interventions: A 49-year-old woman, who was initially diagnosed with stage III rectal cancer (T3N+ disease), underwent neoadjuvant chemoradiation. Subsequently, she had a planned robotic low anterior resection (LAR) with a diverting loop ileostomy. She was then upstaged and found to have metastasis to the lungs and was started on adjuvant chemotherapy with bevacizumab. During this time she was evaluated for ileostomy reversal, but was found to have a chronic anastomotic dehiscence and her reversal was held. She was asymptomatic at that time.A month later, which was three months post-operation, she presented with back pain. She was hospitalized due to sepsis, caused by a soft tissue infection in her back, in the context of a previously managed chronic anastomotic dehiscence.Results/Outcomes: After being admitted to the hospital, the patient was treated with broad-spectrum intravenous antibiotics. Subsequently, she underwent a drainage of the soft tissue collection, followed by the application of an endoscopic vacuum-assisted closure (EndoVac) device. The EndoVac was placed into the cavity of the anastomotic dehiscence, which was about 2cm from the anal verge. The EndoVac was changed on a weekly basis, effectively managing the anastomotic dehiscence.Conclusion/

Discussion: This case underscores the significant potential of Endovac therapy as a non-invasive and promising surgical alternative for the treatment of select cases of anastomotic leak and prevention of permanent stoma. Notably, Endovac demonstrates a high rate of success with minimal associated complications, thus affirming its efficacy in the management of complex clinical scenarios and reinforcing its prominence within the field of colorectal surgery.Figure 1: Anastomotic dehiscence with a large contained leak, treated with endoscopic vacuum therapy (EndoVac)(Upper Section) Customization of EndoVac. (Lower Section) An endoscopic view of a patient with a contained anastomotic leak following neoadjuvant chemoradiation and robotic low anterior resection with diverting ileostomy. This reveals a large extraperitoneal wound cavity filled with fibrinous and necrotic tissue. After the placement of endoscopic vacuum therapy, the wound cavity starts to clean and granulation tissue begins to increase. The EndoVac is successfully removed when the cavity is almost completely sealed, exhibiting full granulation on the 22nd day.