Table 2.
Timing of leakage diagnosis and subsequent treatment with detailed description of reinterventions and readmissions
| Conventional (n = 59) | EVASC (n = 23) | EVT (n = 12) | Transanal suturing (n = 6) | Redo (n = 3) | |
|---|---|---|---|---|---|
| Interval from LAR to AL diagnosis in days (IQR) | 5 (3–27) | 7 (4–14) | 6 (2–12) | 8.5 (4–19) | 4 (NA) |
| < 14 days | 40 (68%) | 18 (78%) | 10 (83%) | 4 (67%) | 3 (100%) |
| < 30 days | 46 (78%) | 20 (87%) | 11 (92%) | 6 (100%) | 3 (100%) |
| < 90 days | 54 (92%) | 23 (100%) | 11 (92%) | 6 (100%) | 3 (100%) |
| Interval from LAR to first reintervention for AL in days (IQR) | 7 (4–20) | 7 (4–16) | 8 (3–20) | 11 (4–55) | 5 (NA) |
| Reinterventions—all | |||||
| Median (IQR) | 2 (1–3) | 8 (6–12) | 9 (5–16) | 2.5 (2–5) | 2 (NA) |
| Reinterventions—excluding stoma creation/closure | 31 (53%) | 23 (100%) | 12 (100%) | 6 (100%) | 3 (100%) |
| Median (IQR) | 1 (0–1) | 7 (5–10) | 8 (4–15) | 1.5 (1–4) | 2 (NA) |
| Radiological reintervention | 7 (12%) | 6 (26%) | 3 (25%) | 0 | 0 |
| Median (IQR) | 0 (0–0) | 0 (0–1) | 0 (0–1) | NA | NA |
| Endoscopic reinterventions | 3 (5%) | 23 (100%) | 12 (100%) | 1 (17%) | 1 (33%) |
| Median (IQR) | 0 (0–0) | 4 (3–6) | 6 (3–9) | 0 (0–0) | 0 (NA) |
| Endoscopic vacuum therapy | 1 (2%) | 23 (100%) | 12 (100%) | 0 | 1 (33%) |
| Sponge series (IQR) | 0 (0–0) | 1 (1–1) | 1 (1–1) | NA | 0 (NA) |
| Sponge exchanges (IQR)a | 4 (NA) | 3 (2–8) | 5 (3–8) | NA | 3 (NA) |
| Surgical reinterventions—all | 53 (90%) | 23 (100%) | 12 (100%) | 6 (100%) | 3 (100%) |
| Median (IQR) | 2 (1–2) | 3 (3–4) | 3 (2–4) | 2.5 (2–4) | 2 (NA) |
| Surgical reinterventions—excluding stoma creation/closure | 26 (44%) | 23 (100%) | 11 (92%) | 6 (100%) | 3 (100%) |
| Median (IQR) | 0 (0–1) | 1 (1–3) | 2 (2–3) | 1.5 (1–3) | 1 (NA) |
| Surgical drainage | 26 (44%) | 5 (22%) | 6 (50%) | 3 (50%) | 0 |
| Median (IQR) | 0 (0–1) | 0 (0–0) | 1 (0–1) | 0.5 (0–1) | 0 (0–0) |
| Washout | 6 (10%) | 7 (30%) | 7 (58%) | 3 (50%) | 0 |
| Median (IQR) | 0 (0–0) | 0 (0–1) | 1 (0–2) | 0.5 (0–1) | 0 (0–0) |
| Other (e.g. rectal catheter debridement fistula etc.) | 14 (24%) | 5 (22%) | 10 (83%) | 3 (50%) | 1 (33%) |
| Median (IQR) | 0 (0–0) | 0 (0–0) | 1 (1–1) | 0.5 (0–2) | 0 (NA) |
| Transanal closure | 5 (9%) | 23 (100%) | 3 (25%)b | 6 (100%) | 0 |
| Median (IQR) | 0 (0–0) | 1 (1–2) | 0 (0–1) | 1 (1–1) | 0 (0–0) |
| Redo-anastomosis | – | – | – | – | 3 (100%) |
| Median (IQR) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 1 (1–1) |
| Resection anastomosis with end-colostomy | 14 (24%) | 4 (17%) | 4 (33%) | 1 (17%) | 0 |
| Median (IQR) | 0 (0–0) | 0 (0–0) | 0 (0–1) | 0 (0–0) | 0 (0–0) |
| Stoma-related surgical reinterventions | |||||
| Creation/correction of stoma | 19 (31%) | 14 (71%) | 4 (33%) | 1 (17%) | 3 (100%) |
| Median (IQR) | 0 (0–1) | 1 (0–1) | 0 (0–1) | 0 (0–0) | 1 (1–1) |
| Ileostomy reversal | 38 (64%) | 22 (96%) | 5 (42%) | 6 (100%) | 3 (100%) |
| Median (IQR) | 1 (0–1) | 1 (1–1) | 0 (0–1) | 1 (1–1) | 1 (1–1) |
| Readmissions | 50 (85%) | 23 (100%) | 9 (75%) | 6 (100%) | 3 (100%) |
| Median (IQR) | 1 (1–2) | 2 (1–4) | 2 (0–3) | 3 (2–4) | 2 (NA) |
| Readmissions—excluding stoma creation/closure | 32 (54%) | 16 (70%) | 9 (75%) | 5 (83%) | 2 (56%) |
| Median (IQR) | 1 (0–1) | 1 (0–3) | 2 (0–3) | 2 (1–3) | 1 (NA) |
| Treatment for AL | 17 (29%) | 14 (61%) | 8 (67%) | 3 (50%) | 1 (33%) |
| Median (IQR) | 0 (0–1) | 1 (0–2) | 1 (0–1) | 1 (0–2) | 0 (NA) |
| Ileus | 5 (9%) | 1 (4%) | 2 (33%) | 2 (33%) | 0 |
| Median (IQR) | 0 (0–0) | 0 (0–0) | 0 (0–1) | 0 (0–1) | 0 (0–0) |
| Other | 9 (15%) | 3 (13%) | 2 (17%) | 2 (33%) | 1 (33%) |
| Median (IQR) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–1) | 0 (NA) |
| Stoma-related readmissions | |||||
| Stoma closure | 35 (59%) | 20 (87%) | 2 (17%) | 56 (100%) | 3 (100%) |
| Median (IQR) | 1 (0–1) | 1 (1–1) | 0 (0–0) | 1 (1–1) | 1 (1–1) |
| Stoma-related problems | 6 (10%) | 4 (17%) | 0 | 2 (33%) | 0 |
| Median (IQR) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–1) | 0 (0–0) |
| Length of stay | |||||
| Index admission for LAR in days (IQR) | 12 (7–20) | 15 (5–25) | 30 (18–58) | 10 (5–31) | 10 (NA) |
| During complete FU in days (IQR) | 19 (12–31) | 30 (23–43) | 52 (33–88) | 22 (13–49) | 13 (NA) |
| Total—without stoma closure in days (IQR) | 16 (9–28) | 25 (19–34) | 52 (33–84) | 18 (10–37) | 11 (NA) |
EVASC endoscopic vacuum-assisted surgical closure, EVT endoscopic vacuum therapy, LAR low anterior resection, AL anastomotic leakage, IQR interquartile range, FU follow-up, NA not available
aOnly patients who underwent EVT were included in this analysis
bA total of three patients underwent surgical closure before start of endoscopic vacuum therapy