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Surgical Endoscopic Vacuum Therapy for Defects of the Upper GI Tract
Florian Kuehn*, Florian Janisch, Frank Schwandner, Guido Alsfasser, Leif Schiffmann, Michael C. Gock, Ernst Klar
Dept. of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany
Introduction: Vacuum assisted closure therapy has become popular in nearly every field of surgery. Intracorporal use was first shown for anastomotic leaks after rectal resection. Since a few years vacuum sponge therapy is increasingly being recognized as a new promising method for repairing upper GI defects of different etiology. The principles of VAC therapy remain the same no matter of localization: Continuous or intermittent suction and drainage via an open-pored polyurethane sponge decrease bacterial contamination, secretion, and local edema. At the same time perfusion and granulation is promoted. However, data for EVT of the upper intestinal tract are still scarce and consist of only a few case reports and small patients series with low number of patients.
Objectives: Here, we aimed to analyze treatment spectrum and outcome of EVT for defects of the upper GI tract.
Methods: Retrospective single center analysis of EVT for various defects of the upper GI tract over a time period of four years (2011-2014) with a mean follow-up of 24 months. If necessary, initial endoscopic sponge placement was performed in combination with open surgical revision.
Results: In total, 116 polyurethane sponges were placed in upper gastrointestinal defects of 19 patients with a median age of 72 years (range, 49-80). Most frequent indication for EVT were anastomotic leakage after esophageal or gastric resection (n=10) and esophageal perforation (n=5). The median number of sponge insertions was five (range, 1-19) with a mean changing interval of three days (range, 1-5). Median time of therapy was 14 days. A successful vacuum therapy for upper intestinal defects with local control of the septic focus was achieved in 17 of 19 patients (89.5%).
Conclusion: EVT is a promising approach for postoperative, iatrogenic, or spontaneous lesions of the upper GI tract. If necessary the endoscopic procedure can be combined with operative revision for better control of the local septic focus. In our series EVT evolved as an alternative treatment modality to stent placement for the control of upper GI-tract anastomotic leakage.
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