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Pouch leak can affect up to 20% of patients in the first year after surgery. Treatment options will take in consideration the timing to diagnosis and the presentation. In this lecture, Dr. Willem Bemelman MD PhD shows the role of vacuum therapy in the treatment of pouch leaks and some results of his institution's study on the matter. Vacuum therapy with early closure was instituted with good results, not only regarding function of the pouch but also chronic sinuses and redo surgery.