Rachel B Scott1, Lane A Ritter2, Amber L Shada3, Sanford H Feldman4, Daniel E Kleiner5. 1. Department of Surgery, Western Connecticut Health System, 24 Hospital Avenue, Danbury, CT, 06810, USA. rachel.scott@wchn.org. 2. Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA. 3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 4. Center for Comparative Medicine, University of Virginia, Charlottesville, VA, USA. 5. Department of Surgery, Western Connecticut Health System, 24 Hospital Avenue, Danbury, CT, 06810, USA.
Abstract
BACKGROUND: Roux-en-Y gastric bypass (RYGB) consistently produces the most sustainable weight loss among common interventions for morbid obesity. Anastomotic leaks at the gastrojejunal (GJ) connection result in severe morbidity. We apply endoluminal negative pressure vacuum devices (EVD) to heal anastomotic leaks in a swine model. METHODS: RYGB was performed in 10 pigs (3 control, 7 experimental). GJ anastomoses were fashioned, and a 2-cm defect was made across the staple line. In controls, the defects remained open. In experimental pigs, the EVD was placed across the defect and kept at continuous 50 mmHg suction. All pigs were euthanized on postoperative day seven unless they displayed signs of peritonitis or sepsis. Fluoroscopy and necropsy were performed to assess a persistent leak, and tissue specimens were sent to histology to evaluate for degree of inflammation and ischemia. RESULTS: All three control pigs' GJ anastomoses demonstrated evidence of a persistent leak. All seven experimental pigs with the EVD in place showed evidence that their leak had sealed at time of fluoroscopy (p value 0.008). CONCLUSIONS: Endoluminal vacuum therapy is well tolerated in a swine model. GJ anastomotic leaks were consistently sealed with our device in place compared to controls. This therapy shows promise as a method to address GJ leaks in the bariatric population, and thus, we believe additional evaluation is warranted.
BACKGROUND: Roux-en-Y gastric bypass (RYGB) consistently produces the most sustainable weight loss among common interventions for morbid obesity. Anastomotic leaks at the gastrojejunal (GJ) connection result in severe morbidity. We apply endoluminal negative pressure vacuum devices (EVD) to heal anastomotic leaks in a swine model. METHODS: RYGB was performed in 10 pigs (3 control, 7 experimental). GJ anastomoses were fashioned, and a 2-cm defect was made across the staple line. In controls, the defects remained open. In experimental pigs, the EVD was placed across the defect and kept at continuous 50 mmHg suction. All pigs were euthanized on postoperative day seven unless they displayed signs of peritonitis or sepsis. Fluoroscopy and necropsy were performed to assess a persistent leak, and tissue specimens were sent to histology to evaluate for degree of inflammation and ischemia. RESULTS: All three control pigs' GJ anastomoses demonstrated evidence of a persistent leak. All seven experimental pigs with the EVD in place showed evidence that their leak had sealed at time of fluoroscopy (p value 0.008). CONCLUSIONS: Endoluminal vacuum therapy is well tolerated in a swine model. GJ anastomotic leaks were consistently sealed with our device in place compared to controls. This therapy shows promise as a method to address GJ leaks in the bariatric population, and thus, we believe additional evaluation is warranted.
Authors: Amber L Shada; Laura H Rosenberger; Mark J Mentrikoski; Michael A Silva; Sanford H Feldman; Daniel E Kleiner Journal: Surg Infect (Larchmt) Date: 2014-01-29 Impact factor: 2.150
Authors: Sukhyung Lee; Brennan Carmody; Luke Wolfe; Eric Demaria; John M Kellum; Harvey Sugerman; James W Maher Journal: J Gastrointest Surg Date: 2007-06 Impact factor: 3.267