Perioperative management - Endo-SPONGE® endoluminal vacuum therapy in lower GI tract staple line failure

Staple line failure is the most significant complication after deep anterior rectal resection.
. Because of the immediate proximity of the sphincter to the anastomosis, there is a permanent backup of infected secretions and gas into the intestinal lumen.
Once staple line failure has occurred, primary extraperitoneal inflammation develops in the vicinity of the anastomosis, localized in the lesser pelvis. If inflammation remains localized and endoscopy demonstrates a cavity, Endo-SPONGE® endoluminal vacuum therapy can be employed.
This requires a functioning protective ileostomy, usually fashioned during the initial procedure.

• Generalized peritonitis
• No wound cavity on endoscopy
• Intraperitoneal wound cavity, with the walls of the cavity being formed by loops of small intestine. Otherwise, intraperitoneal localized perforations can also be managed with the sponge.

The open pores of the polyurethane sponge distribute the suction evenly over all tissue in contact with the sponge surface. This results in:

• Continuous drainage without secretion buildup
• Debridement with rapid cleansing of the wound
• Improved granulation
• Continuous mechanical wound cavity diminution
• Infection control

The Redyrob® Trans Plus is a closed controllable wound drainage system offering the following benefits:

•  Easy operation,
•  Preserving patient mobility,
•  Easy replacement,
•  Filling volume of 600 ml,
•  Quantitative vacuum display showing remaining vacuum capacity.

Secretions are drained into the Redyrob® Trans Plus bottle. The drainage tube passes through the anus and connects with the Redyrob® Trans Plus bottle via a Luer-Lock type Y-connector. Up to two sponges can be connected to the same bottle.
Uniform drainage performance (up to 95% bottle volume) is ensured at all controller settings.
The vacuum controller has 3 positions adjusting the suction as needed.
Level 1 = Low vacuum
Level 2 = Medium vacuum
Level 3 = High vacuum
Only level I may be used with the Endo-SPONGE®!
The applied suction ensures continuous and effective drainage and thus prevents secretions from building up in the cavity.

The Endo-SPONGE® system must be replaced every 48–72 hours:
0.    Flexible endoscopy of the wound cavity with the sponge in place
1.    Disconnect from vacuum
2.    Irrigate and remove the sponge
3.    Insert a new sponge by the same technique as before
There is steady reduction in size and healing of the wound cavity.