Endo-SPONGE® endoluminal vacuum therapy in lower GI tract staple line failure - general and visceral surgery

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  • Endo-SPONGE® – Set

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  • Baseline situation

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    The baseline situation is as follows:
    There is a colonic J-pouch with colonic pouch-anal anastomosis. At the blind end of the pouch, suture line failure has resulted in a greasy largish wound cavity.

  • Removing the sponge

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    The wound presented in step 1 was treated with an Endo-SPONGE®, which now needs to be replaced.
    First, check the sponge position with an endoscope. Then disconnect the system from the vacuum by disconnecting the drainage tube and setting the suction to zero. Now disconnect the draining tube at the Y-connector. After opening the application set, remove the syringe and dilator to irrigate the sponge. Insert the dilator into the tube and attach the syringe. Irrigate the sponge by instilling physiological saline or, as in this example, simethicone, a liquid defoamer, and pull.

  • Flexible endoscopy and sizing the wound cavity

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    Introduce the endoscope and inspect the wound cavity. A clean granulating surface is already visible at the fundus of the wound cavity, while further proximad considerable detritus and fibrin are evident. Remove the detritus from the wound cavity with endoscopic forceps. Now measure the length of the wound cavity to determine the exact size of the sponge. Next, cut the sponge to that size.

    Note:

    1. The Endo-SPONGE® system is made of an open-pore polyurethane sponge firmly connected to a drainage tube.
    2. The sponge should decrease in size with each replacement allowing the wound cavity to shrink as well.
  • Inserting the overtube

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    As the next step, fill the overtube with gel and advance under direct vision as far as the end of the wound cavity, using the endoscope as a guide. Anchor the overtube in this position and withdraw the endoscope.

  • Sponge placement principle

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    • Wet the sponge with gel,
    • Insert it into the overtube,
    • Advance it with the pusher.

    Note: The sponge has reached the end of the overtube when the black mark on the pusher is aligned with the end of the overtube. Release the sponge by pulling back the overtube.

    • Release the sponge by pulling back the overtube.
  • Inserting the sponge with overtube and pusher

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    Now wet the sponge with Askina® gel (aluminum sulphate), compress it and insert it into the overtube. Thread the pusher onto the drainage tube and advance the sponge through the overtube to the end of the wound cavity (= mark on the pusher if the sponge is not cut to size).

    Note: Askina® gel is a crystal clear, viscous, sterile gel that induces the body's own wound cleansing mechanisms Askina® gel promotes healing by creating moist wound conditions.

  • Releasing the sponge and checking its position

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    Release the sponge in the cavity by pulling back the overtube to no more than the pusher handle while simultaneously anchoring the pusher in place. Next, pull back the overtube and pusher together and withdraw. Check endoscopically for ideal sponge placement.

    Note:

    0. The sponge should not be in contact with the intact mucosa.

    1. More than one Endo-SPONGE® may be inserted depending on the size of the wound cavity. More than two sponges requires a second drainage system.

  • Connecting to the bottle

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    Connection with the Y-connector is made easier if the end of the drainage tube is cut at an angle. Do not cut the Y-connector itself so as to avoid suction leakage. Now connect to the Redyrob® Trans Plus (adjustable wound drainage system). Once the entire system has been connected, set the bottle to level 1, thus placing the system under suction. The suction causes the walls of the leakage cavity to contract. The open pores of the sponge distribute the suction evenly over all tissue in contact with the sponge surface. For patient comfort, the bottle can be carried in a bag.
    Caution! Only level I may be used with the Endo-SPONGE®!
    Note: For large wound cavities,a second sponge can be connected with the Y-connector.

  • Final outcome

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    The Endo-SPONGE® system must be replaced every 48–72 hours. There is steady reduction in size and healing of the wound cavity.

    Key Note:
    The sponge should decrease in size with each replacement allowing the wound cavity to shrink as well.