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Endoscopic Vacuum Therapy (EVT)—a New Concept for Complication Management in Bariatric Surgery

Obesity Surgery volume 27, pages 2499–2505 (2017)Cite this article

Abstract

Background

Bariatric surgery is the most efficient therapy for morbid obesity. Staple line and anastomotic leakage are the most feared postoperative complications after Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy (LSG). Traditional treatment options like revisional surgery and endoscopic stent placement are associated with high morbidity and mortality as well as variable success rates. Endoscopic vacuum therapy (EVT) has shown to be a new successful and feasible treatment option for leaks of different etiology after major gastro-esophageal surgery.

Method

We report a case of the EVT principle being applied in a patient with three major leaks located apart from each other within the gastric staple line after LSG for morbid obesity (BMI 62.7). EVT was initiated on postoperative day 8.

Results

In total, 18 endoscopic interventions were performed in 72 days, the vacuum sponge being replaced endoscopically every 4 days. Hospital length of stay was 106 days. No relevant procedure related complications were observed during the course of therapy and during the follow up.

Conclusion

EVT of postoperative leaks in the upper GI tract has been shown to be feasible and safe. It combines defect closure and effective drainage and allows a periodic inspection of the wound cavity. In case of therapeutic failure, it does not jeopardize surgical repair or stent placement. Even though the techniques and materials used in EVT still vary considerably according to local expertise, EVT has the potential to succeed as a nonsurgical, feasible, safe, and effective treatment option for postoperative leaks in bariatric surgery.

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Abbreviations

GI:

Gastrointestinal

RYGB:

Roux-en-Y gastric bypass

LSG:

Laparoscopic sleeve gastrectomy

SEMS:

Self-expanding metal stent

SEPS:

Self-expanding plastic stent

EVT:

Endoscopic vacuum therapy

NPWT:

Negative pressure wound therapy

CT:

Computed tomography

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Affiliations

  1. Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. W1, D-48149, Muenster, Germany

    Fabian Schmidt, Rudolf Mennigen, Thorsten Vowinkel, Philipp A. Neumann, Norbert Senninger, Daniel Palmes & Mike G. Laukoetter

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  1. Fabian Schmidt
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  2. Rudolf Mennigen
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  3. Thorsten Vowinkel
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  4. Philipp A. Neumann
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  6. Daniel Palmes
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  7. Mike G. Laukoetter
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Corresponding author

Correspondence to Mike G. Laukoetter.

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Conflicts of Interest

Fabian Schmidt, Rudolf Mennigen, Thorsten Vowinkel, Philipp A. Neumann, Norbert Senninger, and Daniel Palmes declare that they have no conflicts of interest to disclose. Mike G. Laukoetter is a member of the expert panel of negative pressure wound therapy of the Paul Hartmann (AG) holding company. He received fees for invited speeches on endoscopic vacuum therapy.

Informed Consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from the individual participant for whom identifying information is included in this article.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Schmidt, F., Mennigen, R., Vowinkel, T. et al. Endoscopic Vacuum Therapy (EVT)—a New Concept for Complication Management in Bariatric Surgery. OBES SURG 27, 2499–2505 (2017). https://doi.org/10.1007/s11695-017-2783-6

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  • DOI: https://doi.org/10.1007/s11695-017-2783-6

Keywords

  • Laparoscopic sleeve gastrectomy
  • Endoscopic vacuum therapy
  • EVT
  • Negative pressure wound therapy
  • Bariatric surgery
  • Obesity
  • Anastomotic leakage
  • Postoperative complications
  • Therapeutic endoscopy