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Surgical Endoscopic Vacuum Therapy for Anastomotic Leakage and Perforation of the Upper Gastrointestinal Tract

Journal of Gastrointestinal Surgery volume 16, pages 2145–2150 (2012)Cite this article

Abstract

Introduction

Emergency operations for perforations and anastomotic leakage of the upper gastrointestinal tract are associated with a high overall morbidity and mortality rate. An endoscopic vacuum therapy (EVT) has been established successfully for anastomotic leakage after rectal resection but only limited data exist for EVT of the upper GI tract.

Methods

We report on a series of nine patients treated with EVT for defects of the upper intestinal tract between March 2011 and May 2012. In four patients, initial endoscopic sponge placement was performed in combination with open surgical revision. Median follow-up was 189 (range, 51–366) days.

Results

In total, 52 vacuum sponges were placed in upper GI defects of nine patients. Indication for EVT were anastomotic leakage after esophageal resection or gastrectomy (n = 5) and iatrogenic or spontaneous esophageal perforations (n = 4). The mean number of sponge insertions was six (range, 1–13) with a mean changing interval of 3.5 days (range, 2–5). A successful vacuum therapy for upper intestinal defects was achieved in eight of nine patients (89 %).

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.

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References

  1. Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg. 1993; 96: 488–492.

    PubMed  CAS  Google Scholar 

  2. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997; 38: 563–576;

    PubMed  Article  CAS  Google Scholar 

  3. Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc. 2008; 22:1818–1825.

    PubMed  Article  Google Scholar 

  4. Ahrens M, Schulte T, Egberts J, Schafmayer C, Hampe J, Fritscher-Ravens A, Broering DC, Schniewind B. Drainage of esophageal leakage using endoscopic vacuum therapy: a prospective pilot study. Endoscopy. 2010; 42: 693–698.

    PubMed  Article  CAS  Google Scholar 

  5. Loske G, Schorsch T, Müller C. Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach. Endoscopy. 2011 Jun; 43: 540–544.

    PubMed  Article  CAS  Google Scholar 

  6. Weidenhagen R, Hartl WH, Gruetzner KU, Eichhorn ME, Spelsberg F, Jauch KW. Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg. 2010; 90: 1674–1681.

    PubMed  Article  Google Scholar 

  7. Huber-Lang M, Henne-Bruns D, Schmitz B, Wuerl P. Esophageal perforation: principles of diagnosis and surgical management. Surg Today. 2006; 36: 332–340.

    PubMed  Article  Google Scholar 

  8. Page RD, Shackcloth MJ, Russell GN, Pennefather SH. Surgical treatment of anastomotic leaks after oesophagectomy. Eur J Cardiothorac Surg. 2005; 27: 337–343.

    PubMed  Article  Google Scholar 

  9. Tsou CC, Lo SS, Fang WL, Wu CW, Chen JH, Hsieh MC, Shen KH Risk factors and management of anastomotic leakage after radical gastrectomy for gastric cancer. Hepatogastroenterology. 2011; 58: 218–223.

    PubMed  Google Scholar 

  10. Lang H, Piso P, Stukenborg C, Raab R, Jähne J. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol. 2000; 26:168–171.

    PubMed  Article  CAS  Google Scholar 

  11. Kim RH, Takabe K. Methods of esophagogastric anastomoses following esophagectomy for cancer: A systematic review. J Surg Oncol. 2010; 101: 527–533.

    PubMed  Article  Google Scholar 

  12. Kuppusamy MK, Felisky C, Kozarek RA, Schembre D, Ross A, Gan I, Irani S, Low DE. Impact of endoscopic assessment and treatment on operative and non-operative management of acute oesophageal perforation. Br J Surg. 2011; 98: 818–824.

    PubMed  Article  CAS  Google Scholar 

  13. Doniec JM, Schniewind B, Kahlke V, Kremer B, Grimm H. Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy. 2003; 35: 652–658.

    PubMed  Article  CAS  Google Scholar 

  14. Langer FB, Wenzl E, Prager G, Salat A, Miholic J, Mang T, Zacherl J. Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg. 2005; 79: 398–403;

    PubMed  Article  Google Scholar 

  15. Shaker H, Elsayed H, Whittle I, Hussein S, Shackcloth M. The influence of the ‘golden 24-h rule’ on the prognosis of oesophageal perforation in the modern era. Eur J Cardiothorac Surg. 2010; 38: 216–222.

    PubMed  Article  Google Scholar 

  16. Nishikawa K, Yanaga K, Kashiwagi H, Hanyuu N, Iwabuchi S. Significance of intraoperative endoscopy in total gastrectomy for gastric cancer. Surg Endosc. 2010, 10: 2633–2636.

    Article  Google Scholar 

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Affiliations

  1. Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany

    F. Kuehn, L. Schiffmann, B. M. Rau & E. Klar

Authors
  1. F. Kuehn
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  2. L. Schiffmann
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  3. B. M. Rau
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  4. E. Klar
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Corresponding author

Correspondence to F. Kuehn.

Additional information

F. Kuehn and L. Schiffmann contributed equally to this study.

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Kuehn, F., Schiffmann, L., Rau, B.M. et al. Surgical Endoscopic Vacuum Therapy for Anastomotic Leakage and Perforation of the Upper Gastrointestinal Tract. J Gastrointest Surg 16, 2145–2150 (2012). https://doi.org/10.1007/s11605-012-2014-3

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  • DOI: https://doi.org/10.1007/s11605-012-2014-3

Keywords

  • Anastomotic leakage
  • Perforation
  • Esophageal
  • Endoscopy
  • Vacuum therapy