Early innovative Closure of Leaking low colorEctal ANastomoses; a multicenter study.

Due to an expected increase in colorectal cancer there will be a subsequent increase in Low Anterior Resections (LAR). Anastomotic leakage can occur in up to 11% of the patients after a LAR for colorectal carcinomas. Leakage interferes with stoma reversal, might compromise pouch function later on, and might result in a chronic presacral sinus precluding defect closure. A relative new technique for the treatment of anastomotic leakage is endosponge® treatment. However the traditional endosponge® treatment is associated with high material costs and a long duration of treatment. Therefore a complete new technique was developed. The early closure of the anastomotic dehiscense after endosponge® therapy might overcome these drawbacks and reduce the costs, improve the neorectum function, quality of life and improve ileostomy reversal.

3, 6, 9 and 12 months

As soon as the anastomotic insufficiency is diagnosed, the anastomosis is defunctioned if not done so primarily. If the CT scan shows extravasation of enteral contrast in a presacral cavity, the patient is sent to the department of Gastroenterology of one of the three intervention centers to have an endoscopy to evaluate the level of anastomosis, the size of the defect and the size of the presacral cavity. In day care one or more Endosponges® are placed in the presacral cavity in order to clean the cavity prior to closure of the anastomotic defect. The treatment is continued until the cavity is clean. Within 7 – 14 days after initiation of Endosponge® treatment, the anastomotic gap is attempted to close with interrupted sutures under general anesthetics. If not succesfull, Endosponge® treatment is continued until closure of the cavity.