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Endoscopic vacuum assisted wound closure (EVAC) device to treat esophageal and gastric leaks: assessing time to proficiency and cost

  • Marc A. Ward
  • Tareq Hassan
  • James S. Burdick
  • Steven G. LeedsEmail author
Article

Abstract

Background

Endoluminal vacuum therapy (EVAC) is an emerging procedure used to treat anastomotic leaks and/or perforations that would otherwise require surgery. The aim of this study was to determine time to proficiency in EVAC and the cost effectiveness of the procedure.

Methods

We retrospectively reviewed a prospectively maintained IRB approved database for all patients undergoing EVAC after esophageal and gastric complications between October 2013 and December 2017. Proficiency was determined by obtaining predicted estimates and analyzing the point at which average procedure time plateaued based on case volume. Total cost was calculated based on supplies and location where the procedure was performed.

Results

There were 50 patients (17 males, 33 female), with a mean age of 52.1 years. EVAC was placed in 23 (46%) patients with esophageal injuries and 28 (56%) with gastric injuries. Two advanced endoscopists performed all EVAC procedures in this study (1 surgeon, 1 gastroenterologist). The average procedure time for all patients was 43.5 min and the average wheel in/wheel out time for all patients was 75.6 min. Analysis of the trend based on average procedure times for EVAC revealed that proficiency was obtained after 10 cases. Total cost of the procedure is significantly lower in the GI lab compared to the operating room ($4528 vs. $11889). The majority of EVAC were performed in the GI lab (62%) compared to the operating room (38%).

Conclusion

Successful outcomes in managing anastomotic leaks or intestinal perforations non-operatively has led to an increased interest in EVAC. For advanced endoscopists, time to proficiency is approximately 10 cases. Performing the procedure in the GI lab has a 2.5 reduction in total cost compared to the operating room.

Keywords

Endoscopic vacuum assisted closure Proficiency Cost utilization Anastomotic leak Intra-abdominal perforation 

Abbreviations

EVAC

Endoscopic vacuum assisted closure

GI

Gastroenterology laboratory

NG

Nasogastric tube

OR

Operation room

TEF

Tracheoesophageal fistula

Notes

Compliance with Ethical Standards

Disclosures

Steven Leeds is a consultant for Ethicon, which has no relevance to the information produced in the manuscript above. Marc Ward, Tarek Hassan, and James Burdick have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Minimally Invasive SurgeryBaylor University Medical CenterDallasUSA
  2. 2.Center for Advanced SurgeryBaylor Scott and White HealthDallasUSA
  3. 3.Advanced Endoscopic ConsultantsBaylor University Medical CenterDallasUSA
  4. 4.Division of Minimally Invasive SurgeryBaylor University Medical CenterDallasUSA

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