Clinical Scorecard: Endoluminal Vacuum Therapy Using VACStent for Managing Anastomotic Leaks in Colorectal Surgery: A Pilot Investigation to Avoid Stoma Formation

At a Glance

Key Highlights

• AL incidence ranges from 2% to 39%, with higher risk for low anastomoses near the anal verge.
• Traditional sponge-assisted EVT requires stoma and occludes bowel lumen; VACStent allows endoluminal vacuum therapy without bowel obstruction.
• VACStent combines a covered nitinol stent with polyurethane sponge and vacuum suction to enable drainage, wound conditioning, and stent fixation.

Guideline-Based Recommendations

Diagnosis

• Endoscopic confirmation of anastomotic leak and wound cavity size.
• Use of intraoperative air bubble test to identify technical anastomotic problems.

Management

• Early initiation of vacuum-assisted therapy improves success rates.
• VACStent deployment via transanal endoscopy with continuous suction pressure of -80 to -125 mmHg.
• Preemptive VACStent placement may substitute prophylactic stoma in high-risk anastomoses.
• Stool conditioning with fiber-free nutrition and laxatives to ensure soft fecal passage during treatment.

Monitoring & Follow-up

• Regular endoscopic evaluation to assess wound healing and stent position.
• Retrograde rinsing of sponge via drainage tube before VACStent removal.
• Suction should be stopped 2 to 4 hours prior to device removal.
• Standard anastomosis check on postoperative day 7 or earlier if clinically indicated.

Risks

• Potential stent migration is minimized by vacuum suction fixation.
• Delayed diagnosis of AL can lead to increased morbidity and need for permanent stoma.
• Sponge-assisted EVT without VACStent may require permanent stoma in over 40% of cases.

Patient & Prescribing Data

Patients with colorectal anastomotic leaks or high-risk anastomoses post colorectal surgery

VACStent allows minimally invasive management of AL without stoma formation, with recommended device dwell time of 3 to 7 days and continuous vacuum suction.

Clinical Best Practices

• Perform transanal endoscopy with guide wire placement for precise VACStent deployment.
• Use continuous negative pressure suction (-80 to -125 mmHg) for effective drainage and stent fixation.
• Ensure retrograde rinsing of sponge and cessation of suction before device removal to facilitate safe extraction.
• Advise fiber-free nutrition and stool softeners to maintain fecal passage during treatment.
• Consider VACStent for both treatment of established AL and preemptive coverage in high-risk anastomoses to avoid stoma.

References

• Lange et al. Description of VACStent
• Clinical trial registry NCT04884334
• EVT Academy VACStent application videos