Management of Colorectal Anastomotic Leaks With Endoluminal Vacuum Therapy: A Pragmatic Summary of the Evidence and Definition of Clinical Practices for Patient Selection, Technique, and Follow-up

Endoluminal vacuum therapy (EVT) is a promising intervention for colorectal anastomotic leaks, supported by observational evidence but limited by lack of standardization and RCTs. Key uncertainties include criteria for fecal diversion, outpatient feasibility, and the role of defect size in predicting success. Clinical registries and standardized protocols are essential to guide practice and optimize patient selection. Long-term functional outcomes remain underreported, underscoring the need for structured follow-up and counseling. EVT's future integration into colorectal surgery hinges on collaborative, prospective research and systematized implementation.