Abdullah GÜNEŞ, Ömer AKAY, Murat ÖZDAMAR
Turkish Journal of Colorectal Disease - 2026;36(2):54-61
Aim: Anastomotic leakage (AL) remains one of the most serious complications following rectal cancer surgery, particularly in low rectal anastomoses. Endoluminal vacuum therapy (EVT) has emerged as a minimally invasive treatment option aimed at controlling pelvic sepsis and preserving the anastomosis. This study aimed to evaluate the clinical outcomes, safety, and feasibility of EVT in the management of AL following rectal cancer resection. Method: A retrospective two-center case series was conducted between January 2020 and December 2025, including patients who developed AL following rectal cancer surgery and were treated with EVT. Clinically stable patients without generalized peritonitis were included, whereas patients requiring emergency surgical intervention were excluded. Demographic characteristics, leakage features, EVT-related variables, treatment outcomes, and complications were analyzed. Results: A total of 13 patients were included in the study. The mean age was 57.7+/-12.3 years, and all patients had a protective diverting stoma at the time of EVT initiation. AL was diagnosed at a median of 10 postoperative days (range, 6-115), with most leaks located in low rectal anastomoses (mean leak level: 4.7+/-1.8 cm from the anal verge); EVT was initiated at a median of 12 postoperative days (range, 8-120). The median number of EVT sessions was three (range, 2-6), and the median time to clinical healing was 16 days (range, 12-34). Clinical resolution of AL was achieved in 12 patients, resulting in an overall success rate of 92.3%; EVT-related complications occurred in 2 patients (15.4%), including one anastomotic stricture, successfully managed with endoscopic balloon dilatation, and one rectovaginal fistula, which required a Hartmann procedure and was considered a treatment failure. No pelvic abscess was observed. Diverting ileostomies were closed 1 month after confirmed healing in all eligible patients. Conclusion: EVT appears to be a promising and feasible minimally invasive treatment option for AL following rectal cancer surgery, particularly in carefully selected clinically stable patients with low rectal anastomoses. The high success rate, acceptable morbidity, and low need for reoperation suggest that EVT may represent a valuable anastomosis-preserving strategy. Larger prospective studies are needed to better define optimal patient selection and treatment timing.
