Endoscopic vacuum therapy and early surgical closure after pelvic anastomotic leak: meta-analysis of bowel continuity rates

F. Borja de Lacy, Kevin Talboom, Sapho X. Roodbeen, Robin Blok, Anna Curell, Pieter J. Tanis, Wilhelmus A. Bemelman, Roel Hompes*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)

Abstract

BACKGROUND: Endoscopic vacuum therapy (EVT) with or without early surgical closure (ESC) is considered an effective option in the management of pelvic anastomotic leakage. This meta-analysis evaluated the effectiveness of EVT in terms of stoma reversal rate and the added value of ESC. METHODS: A systematic search of PubMed, MEDLINE, and the Cochrane Library was conducted in November 2021 to identify articles on EVT in adult patients with pelvic anastomotic leakage. The primary outcome was restored continuity rate. Following PRISMA guidelines, a meta-analysis was undertaken using a random-effects model. RESULTS: Twenty-nine studies were included, accounting for 827 patients with leakage who underwent EVT. There was large heterogeneity between studies in design and reported outcomes, and a high risk of bias. The overall weighted mean restored continuity rate was 66.8 (95 per cent c.i. 58.8 to 73.9) per cent. In patients undergoing EVT with ESC, the calculated restored continuity rate was 82 per cent (95 per cent c.i. 50.1 to 95.4) as compared to 64.7 per cent (95 per cent c.i. 55.7 to 72.7) after EVT without ESC. The mean number of sponge exchanges was 4 (95 per cent c.i. 2.7 to 4.6) and 9.8 (95 per cent c.i. 7.3 to 12.3), respectively. Sensitivity analysis showed a restored continuity rate of 81 per cent (95 per cent c.i. 55.8 to 99.5) for benign disease, 69.0 per cent (95 per cent c.i. 57.3 to 78.7) for colorectal cancer, and 65 per cent (95 per cent c.i. 48.8 to 79.1) if neoadjuvant radiotherapy was given. CONCLUSION: EVT is associated with satisfactory stoma reversal rates that may be improved if it is combined with ESC.

Original languageEnglish
Pages (from-to)822-831
Number of pages10
JournalThe British journal of surgery
Volume109
Issue number9
Early online date30 May 2022
DOIs
Publication statusPublished - 1 Sept 2022

Bibliographical note

Funding Information:
F.B.d.L. and K.T. are joint first authors of this review. The authors thank F. S. van Etten-Jamaludin (AMC Medical Library), who was in charge of the full systematic research process, and S. van Dieren (statistician), who was involved in the data analysis. P.J.T. and R.H. received a grant from B. Braun for a prospective trial (IMARI), but no grants, equipment or drugs have been received for this work. Dr W.A.B. reports grants from VIFOR, grants from Medtronic, and grants from B. Braun, outside the submitted work. The authors declare no other conflict of interest.

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved.

Fingerprint

Dive into the research topics of 'Endoscopic vacuum therapy and early surgical closure after pelvic anastomotic leak: meta-analysis of bowel continuity rates'. Together they form a unique fingerprint.

Cite this