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

  1. Complications

    • Iatrogenic intraperitoneal sponge placement risking intestinal fistula.
      The risk of peritonitis is negligible because the pressure reversal by the vacuum drains the infectious secretions to the outside.
    • Ascending infection with generalized peritonitis → Relaparotomy with targeted drainage and antibiotic therapy, if necessary Hartmann procedure with terminal colostomy.
      However, this is not due to the sponge therapy but to inadequate drainage of the wound secretions.  The most common causes include inadequate vacuum in the drainage container, clogged sponge/catheter, multiloculated wound cavity with incomplete drainage of the infection focus, and sponges that are too small.
    • Entero-anal fistula because of sponge contact with the small bowel
    • Blood loss from minor septic erosive bleeding maintained by the vacuum (on the whole, very rare!)
    • Torn off catheter with sponge loss during removal.
      Recovery with endoscopic forceps can then be quite time-consuming.
    • Sponge ingrowing into the granulation tissue, thus hampering sponge removal and possibly triggering bleeding from the granulation tissue.
    • Intraluminal displacement with obstruction of the intestinal lumen.
      In general, this does not result in ileus because the sponge soon becomes clogged with feces, rendering the system no longer functional and thereby signaling a complication. Since the mucosa itself is completely resistant to the vacuum and the polyurethane sponge, they do not cause any erosions or perforations (in contrast to the serosal side!).