AB013. SOH22ABS194. End-sponge for low rectal anastomotic leak: case series study

Background: Rate of anastomotic leak is considered rare, and the low rectal ones are approximately 10% of all anastomotic leaks. Management of anastomotic leak is variable and could be challenging. ENDO-SPONGE is advised by experts to be considered given some criteria to be met but in general, ENDO-SPONGE is thought to improve patients’ life quality and maintains the possibility of stoma reversal after resolution of the leak. In this study we aim to assess the management of anastomotic leak using ENDO-SPONGE in our hospital and to compare our practice with the international published data.

Methods: Case study of all patients diagnosed with anastomotic leak and treated with ENDO-SPONGE. All cases from 2016 to 2021 were included. Concordance with the NICE briefing and recommendation which was published in 2019 was studied. All data were collected in a Microsoft forms then transcribed onto an Excel sheet.

Results: A total of 13 patients with ENDO-SPONGE changes were found—median age is 66. Guidelines suggest that ENDO-SPONGE changes should occur within 24–72 hours of each other and the compliance from the trust was only 25%. However the compliance with the number of changes, place of insertion, and the outcome was 100%. Ninety-nine percent of the ENDO-SPONGE replacement took place in the theatre room, only one patient’s ENDO-SPONGE had replacement in endoscopy department. Complete resolution of the anastomotic leak occurred in 11 of the 13 patients and only 2 required open drainage. Five out of thirteen patients were eventually reversed.

Conclusions: Our departmental compliance with guidelines is satisfactory for all parameters except timing of exchanges—where only 25% occurred within 72 hours. However, ENDO-SPONGE carried a good outcome with complete resolution in nearly 85% of patients.

Keywords: Anastomotic leak; colorectal surgery; endo-sponge; extra-peritoneal rectal leak; low rectal cancer