EP648 - A Low Cost Endoluminal Vacuum Therapy for Rectal Anastomotic Leaks in a Resource Constraint Setting : Outcomes and Insights

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Purpose/Background: Anastomotic leaks in rectal cancer patients are a significant complication which may result in a disconnection of the anastomosis and end – colostomy .The commercially available endoluminal vacuum technology is expensive and not readily available in our resource limited setting.We aimed to evaluate the efficacy of a novel low cost endoluminal vacuum therapy as an alternative to the commercially available technology.

Methods/Interventions: We retrospectively analyzed the prospective database of the group of patients who had a rectal anastomotic leak after a low anterior resection from January 2021 to July 2024. All patients who were diagnosed to have a extraperitoneal contained leak with no features of peritonitis and underwent a diversion colostomy were included in the study.The initial set of patients , who were treated with IV antibiotics , pigtail insertion and drainage of pelvic collection was labelled as group A. All patients who were treated by endoluminal vacuum therapy was labelled as group B.The primary objective of the study was to ascertain the rates of stoma closure , time to stoma closure and the mean duration of hospital stay in the two groups.
The technique (as illustrated ) consisted of utilising a sterile sponge through with a channel is created by passing a redon curved needle of closed suction drain. The perforated end of the drain catheter remains within the body of the sponge. To further anchor the sponge to drain tube, a 0 – silk suture can be used to transfix the catheter at the top and the bottom. The sponge with drain catheter was railroaded over an endoscopic guide wire and placed in the anastomotic leak cavity in the pararectal space.Vacuum dressing was applied and connected to a portable reusable vacuum unit , set to 100 mm Hg pressure.The sponge was changed after every 48-72

Results/Outcomes: We had a total of 28 patients in group A and 31 patients in group B. The rates of stoma closure in group A was 19 patients (67.8%).Two patients of group A , who had a persistent anastomotic leakage subsequently underwent endoluminal vacuum therapy and underwent successful closure of their stoma.28 patients of group B (90.3%) ,treated with endoluminal vacuum therapy underwent diversion colostomy closure.The time to stoma closure was 120 days and 76 days in group A and group B respectively.The mean duration of endoluminal vacuum therapy was 23 days .The average number of dressing changes was 6 for the endoluminal vacuum therapy.The total cost of one vacuum therapy dressing change in our technique came to 12.74 dollars.The total cost of one session of commercially available endoluminal technology is priced at 327.46 dollars .

Conclusion/Discussion: Our novel endoluminal vacuum setup is a low cost alternative to commercially available apparatus. This can be safely and effectively used to salvage failed rectal anastomoses in hospitals and patients with resource constraints