Marc Bludau1, Hans F Fuchs2, Till Herbold3, Martin K H Maus2, Hakan Alakus2, Felix Popp2, Jessica M Leers2, Christiane J Bruns2, Arnulf H Hölscher4, Wolfgang Schröder2, Seung-Hun Chon2. 1. Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. Marc.Bludau@uk-koeln.de. 2. Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. 3. Department of General, Visceral and Cancer Surgery, RWTH Aachen, Aachen, Germany. 4. Department of General, Thoracic and Vascular Surgery, Agaplesion Markus Hospital, Frankfurt, Germany.
Abstract
BACKGROUND: Esophageal perforations and postoperative leakage of esophagogastrostomies are considered to be life-threatening conditions due to the potential development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC) techniques, a well-established treatment method for superficial infected wounds, are based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy as a treatment for GI leakages in the rectum was introduced in 2008. E-VAC therapy is a novel method, and experience regarding esophageal applications is limited. In this retrospective study, the experience of a high-volume center for upper GI surgery with E-VAC therapy in patients with leaks of the upper GI tract is summarized. To our knowledge, this series presents the largest patient cohort worldwide in a single-center study. METHODS: Between October 2010 and January 2017, 77 patients with defects in the upper gastrointestinal tract were treated using the E-VAC application. Six patients had a spontaneous perforation, 12 patients an iatrogenic injury, and 59 patients a postoperative leakage in the upper gastrointestinal tract. RESULTS: Complete restoration of the esophageal defect was achieved in 60 of 77 patients. The average duration of application was 11.0 days, and a median of 2.75 E-VAC systems were used. For 21 of the 77 patients, E-VAC therapy was combined with the placement of self-expanding metal stents. CONCLUSION: This study demonstrates that E-VAC therapy provides an additional treatment option for esophageal wall defects. Esophageal defects and mediastinal abscesses can be treated with E-VAC therapy where endoscopic stenting may not be possible. A prospective multi-center study has to be directed to bring evidence to the superiority of E-VAC therapy for patients suffering from upper GI defects.
BACKGROUND: Esophageal perforations and postoperative leakage of esophagogastrostomies are considered to be life-threatening conditions due to the potential development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC) techniques, a well-established treatment method for superficial infected wounds, are based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy as a treatment for GI leakages in the rectum was introduced in 2008. E-VAC therapy is a novel method, and experience regarding esophageal applications is limited. In this retrospective study, the experience of a high-volume center for upper GI surgery with E-VAC therapy in patients with leaks of the upper GI tract is summarized. To our knowledge, this series presents the largest patient cohort worldwide in a single-center study. METHODS: Between October 2010 and January 2017, 77 patients with defects in the upper gastrointestinal tract were treated using the E-VAC application. Six patients had a spontaneous perforation, 12 patients an iatrogenic injury, and 59 patients a postoperative leakage in the upper gastrointestinal tract. RESULTS: Complete restoration of the esophageal defect was achieved in 60 of 77 patients. The average duration of application was 11.0 days, and a median of 2.75 E-VAC systems were used. For 21 of the 77 patients, E-VAC therapy was combined with the placement of self-expanding metal stents. CONCLUSION: This study demonstrates that E-VAC therapy provides an additional treatment option for esophageal wall defects. Esophageal defects and mediastinal abscesses can be treated with E-VAC therapy where endoscopic stenting may not be possible. A prospective multi-center study has to be directed to bring evidence to the superiority of E-VAC therapy for patients suffering from upper GI defects.
Authors: Mark L Venturi; Christopher E Attinger; Ali N Mesbahi; Christopher L Hess; Katherine S Graw Journal: Am J Clin Dermatol Date: 2005 Impact factor: 7.403
Authors: Mike G Laukoetter; Rudolf Mennigen; Philipp A Neumann; Sameer Dhayat; Gabriele Horst; Daniel Palmes; Norbert Senninger; Thorsten Vowinkel Journal: Surg Endosc Date: 2016-10-05 Impact factor: 4.584
Authors: D Vallböhmer; A H Hölscher; M Hölscher; M Bludau; C Gutschow; D Stippel; E Bollschweiler; W Schröder Journal: Dis Esophagus Date: 2009-10-26 Impact factor: 3.429
Authors: Sameer A Dhayat; Rosanna Schacht; Rudolf Mennigen; Daniel Palmes; Thomas Vogel; Thorsten Vowinkel; Norbert Senninger; Mike Georg Laukoetter Journal: J Gastrointest Surg Date: 2018-11-14 Impact factor: 3.452
Authors: Felix Berlth; Marc Bludau; Patrick Sven Plum; Till Herbold; Hildegard Christ; Hakan Alakus; Robert Kleinert; Christiane Josephine Bruns; Arnulf Heinrich Hölscher; Seung-Hun Chon Journal: J Gastrointest Surg Date: 2018-10-29 Impact factor: 3.452
Authors: Philip C Müller; Diana Vetter; Joshua R Kapp; Christoph Gubler; Bernhard Morell; Dimitri A Raptis; Christian A Gutschow Journal: Int J Surg Protoc Date: 2021-03-18