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

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.

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.

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.

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.